Survival of cancerIreland: patients Survival in Northern Survival of cancer patients in Northern Ireland: 1993-2004
October 2007
1993-2004
Northern Ireland Cancer Registry
Centre for Clinical and Population Sciences Mulhouse Building Grosvenor Road Belfast BT12 6BJ 5 Tel: (44) 028 9063 2573 Fax: (44) 028 9024 8017 Email: [email protected] Website: www.qub.ac.uk/nicr Contents
CONTENTS
CONTENTS ...... I FOREWORD ...... III ACKNOWLEDGEMENTS ...... IV 01: INTRODUCTION...... 1 02: CANCER IN NORTHERN IRELAND...... 7
03: ALL CANCERS (EXCLUDING NON-MELANOMA SKIN CANCER) (C00-C97, EX. C44)...... 13
04: CANCER OF THE LIP, ORAL CAVITY & PHARYNX (C00-C14)...... 19
05: OESOPHAGEAL CANCER (C15)...... 22
06: STOMACH CANCER (C16)...... 27
07: COLORECTAL CANCER (COLON, RECTOSIGMOID JUNCTION & ANUS) (C18-C21) ...... 32
08: CANCER OF THE COLON (C18)...... 40
09: CANCER OF THE RECTUM, RECTOSIGMOID JUNCTION & ANUS (C19-C21) ...... 45
10: LIVER CANCER (C22) ...... 49
11: PANCREATIC CANCER (C25) ...... 52
12: CANCER OF THE LARYNX (C32)...... 55
13: LUNG CANCER (TRACHEA, BRONCHUS & LUNG) (C33-C34) ...... 58
14: MALIGNANT MELANOMA (C43) ...... 65
15: MESOTHELIOMA (C45)...... 71
16: BREAST CANCER (FEMALES ONLY) (C50)...... 73
17: CERVICAL CANCER (C53) ...... 79
18: CANCER OF THE UTERUS (C54)...... 84
19: OVARIAN CANCER (C56) ...... 88
20: PROSTATE CANCER (C61) ...... 93
21: TESTICULAR CANCER (C62) ...... 99
22: CANCER OF THE KIDNEY (C64-C66, C68)...... 102
23: CANCER OF THE BLADDER (C67) ...... 107
24: CANCER OF THE BRAIN (C71) ...... 112
25: HODGKIN’S DISEASE (C81) ...... 115
26: NON-HODGKIN’S LYMPHOMA (C82-C85, C96) ...... 118
27: MULTIPLE MYELOMA (C90)...... 123
28: LEUKAEMIA (C91-C95)...... 126
29: CHILDHOOD CANCER (AGES 0-14; ALL CANCERS EXCLUDING NMSC)...... 132 A1: ABBREVIATIONS ...... 135 A2: DEFINITIONS ...... 136 A3: STAGING...... 140
A4: INCIDENCE RATES BY SEX AND CANCER SITE (1993-2004) ...... 142
Northern Ireland Cancer Registry i
Survival of cancer patients in Northern Ireland: 1993-2004
A5: MORTALITY RATES BY SEX AND CANCER SITE (1993-2004) ...... 150
A6: ANNUAL PERCENTAGE CHANGES BY SEX AND CANCER SITE (1993-2004) ...... 157
A7: RELATIVE SURVIVAL BY SEX AND CANCER SITE (1993-2004) ...... 159
A8: RELATIVE SURVIVAL BY SEX, AGE AND CANCER SITE (1993-2003) ...... 160 REFERENCES ...... 166
ii
Foreword
FOREWORD
Survival is a measure of many aspects of cancer care including delays in diagnosis, the standard of treatment, its timeliness and the overall quality of care.
There have been many recent changes to Cancer Services in Northern Ireland; such as advice on alarm symptoms; screening for breast and cervical cancer and the re-organisation of cancer services with the aim of all patients having the highest standards of care irrespective of where they live. These survival statistics provide a window through which we can measure the impact of change and even though the time of follow up is short it is pleasing to note detectable improvements.
This report uses new techniques to analyse survival providing us with more up to date data than previously possible. It highlights the importance of cancer registration which allows the measurement of results on a population basis giving a complete picture and not just those treated in ‘centres of excellence’. While measuring improvements, this data also highlights areas where survival has remained unchanged and where we need to concentrate our efforts.
The good news is that survival has improved in both males and females diagnosed from 1997 to 2000 compared with 1993 to 1996. Once again this report emphasises the importance of smoking in the changing patterns of cancer incidence. While lung cancer in men is beginning to decrease, linked with a fall in smoking there is sadly no corresponding decrease among females as they continue to smoke; clearly an area for targeted prevention. Unfortunately smoking levels affect overall survival as tobacco related cancers tend to have poorer survival. Similarly smoking also explains in part the differences in cancer experience linked with social deprivation.
Northern Ireland’s inclusion for the first time, in Eurocare – a pan-European comparison of survival highlights areas where we are doing well and others where improvements are necessary. Much has been achieved and there is still much to do.
As Chairman of the N. Ireland Cancer Registry I congratulate Dr David Donnelly, Dr Anna Gavin and the Registry team for the huge amount of work compiling this report. It has highlighted our cancer survival improvements and where further improvements are possible.
Prof. Roy Spence OBE MA MD FRCS Consultant Surgeon Chairman of Council of Northern Ireland Cancer Registry
Northern Ireland Cancer Registry iii
Survival of cancer patients in Northern Ireland: 1993-2004
ACKNOWLEDGEMENTS
The Northern Ireland Cancer Registry is funded by the Department of Health, Social Services & Public Safety Northern Ireland (DHSSPSNI).
The work of the Northern Ireland Cancer Registry, including the production of this report, is the result of work by the team listed below:
Bernadette Anderson Finian Bannon Denise Catney Linda Caughley Olwyn Dawson David Donnelly Kate Donnelly Deirdre Fitzpatrick Donna Floyd Colin Fox Wendy Hamill Anita Jones Jackie Kelly Gavin Kennedy Heather Kinnear Julie McConnell Susan McGookin Richard Middleton Eamon O’Callaghan Guilio Napolitano Lisa Ranaghan Breige Torrans Timothy Vennard Rosemary Ward
The loan of David Donnelly by the Northern Ireland Statistics and Research Agency (NISRA) is gratefully acknowledged.
Special thanks are due to Riccardo Capocaccia and the EUROCARE working group for provision of EUROCARE-4 data prior to its publication in August 2007. Thanks also to Paul Walsh from the National Cancer Registry, Ireland for his invaluable advice on the latest survival analysis techniques and the provision of STATA algorithms.
I wish also to record my thanks to the Management Group and Council of the Registry who guide this work.
Dr. Anna Gavin Director of Northern Ireland Cancer Registry 2007
iv
Introduction
01: INTRODUCTION
This publication is the third report from the Northern Ireland Cancer Registry (NICR) detailing the survival of cancer patients in Northern Ireland. The first report, produced in 2001, described in detail the survival of patients diagnosed with cancer between 1993 and 19961. Some of the major findings in the report were: • Females had better survival than men; • Younger people had better survival than older people; • Earlier detection improved survival; • Cell type had a significant effect on lung cancer survival; • Survival from malignant melanoma and female breast cancer was excellent; • Survival from lung and male oesophageal cancer was poor.
A comprehensive report of cancer in Northern Ireland produced in 20042 included information on cancer survival with comparisons between the periods 1993-1995 and 1996-1999. This showed improvements in survival for cancers of the breast and colon.
Patient survival is one of the best indicators as to the efficiency of diagnostic and treatment methods in a geographic area3. This report aims to investigate a range of factors that have the potential to impact on patient survival and thereby allow an assessment of the effectiveness of cancer care in Northern Ireland. The report extends the analysis presented previously to include patients diagnosed with cancer between 2000 and 2004. Survival by sex, age and stage for different periods of diagnosis is investigated where information is available and the number of patients is large enough. Survival for patients who have already survived a given length of time is examined and for the four main cancer sites (colorectal, lung, breast and prostate) investigations into the impact of deprivation and urban/rural factors on survival are conducted.
1.1: The Northern Ireland Cancer Registry The Northern Ireland Cancer Registry (NICR) is a population-based registry for the 1.7 million people usually resident in Northern Ireland4. It was established in May 1994, replacing an older, incomplete, paper based registry, which had been established in 1959. NICR is the principal source of information on cancer in Northern Ireland, holding detailed information on cancer incidence and mortality from 1993 onwards.
The Registry is part of the Centre for Clinical & Population Sciences (CCPS) in the School of Medicine & Dentistry, Queen's University of Belfast (QUB) and is funded by the Department of Health & Social Services and Public Safety, Northern Ireland (DHSSPSNI). The Registry is a member of the UK Association of Cancer Registries (UKACR) and has collaborative working links with the National Cancer Registry of Ireland (NCRI) and the National Cancer Institute USA (NCI). Northern Ireland also has data included in EUROCARE, a study investigating survival variations across the countries of Europe. This report includes data from this study.
1.2: Data Collection Methods Data on cancer incidence and mortality are available from multiple sources, primarily pathological records, hospital discharges and death registrations from the General Registrar Office (GRO). This data is captured electronically and is collated and quality assured on a regular basis to provide a population-based registry of cancer incidence for Northern Ireland. The alive/dead status of each cancer patient registered is identified by linking the cancer incidence data to the GRO deaths data, an approach known as passive follow-up.
Tumour details are collected on cancer diagnoses according to the International Classification of Diseases, tenth revision5 (ICD10). The diseases registered include malignant, benign and in-situ neoplasms, and neoplasms of uncertain or unspecified behaviour. For this study records relating to all newly diagnosed malignant cancers and malignant cancer deaths (C00-C97) occurring between 1993 and 2004 were extracted from the Registry. Patients diagnosed with non-melanoma skin cancer (NMSC) (C44) were excluded from any survival analysis of all cancers, as survival from this cancer is excellent.
Northern Ireland Cancer Registry 1
Survival of cancer patients in Northern Ireland: 1993-2004
Patient confidentiality NICR ensures that the confidentiality of patients is protected at all times. Information released is provided only in aggregate form and complies with the Data Protection Act 1998. All results contained in this report have been checked to ensure that individuals cannot be identified. In the event that cells in tables refer to between 1 and 4 patients the cell is suppressed with a “<5” character.
Deprivation quintiles and urban/rural classification NICR captures information on the postcode of usual residence for patients diagnosed with cancer. Postcode information on the Registry database is 99.4% complete (excluding patients with NMSC). Using this data each patient is assigned a Local Government District (LGD) and Census Output Area (COA) of usual residence using the 2006 Central Postcode Directory6 (CPD). In a small number of cases (0.4%) the patient’s postcode is not present on the CPD and an LGD or COA cannot be assigned to the patient. In total 1.0% of all patients have an unknown LGD or COA and these patients are excluded from any geographic based analysis.
Patients are assigned a deprivation quintile using the 2005 Northern Ireland Noble economic deprivation measure7, which assigned a deprivation score to each Census Output Area (COA) in Northern Ireland based upon the economic characteristics of all persons usually resident in that area. For the purposes of this study the COAs were ranked according to this score and divided into quintiles, with quintile 5 containing the fifth of the population resident in the least deprived COAs and quintile 1 containing the fifth of the population resident in the most deprived COAs.
An urban/rural indicator is also applied to each cancer patient based upon postcode of residence using the classification developed for areas in Northern Ireland by the Inter-Departmental Urban-Rural definition group in 20058. This classification uses eight categories ranging from Belfast Metropolitan Urban Area to small villages and open countryside (see appendix 2 for further categories).
Population data All population data used in this report is supplied by the Northern Ireland Statistics and Research Agency (NISRA) and comes either from the 2001 Census of Population9 or the Mid-Year Population Estimates Series10, which uses the 2001 Census figures along with births, deaths and migration data to provide up to date estimates of the population of Northern Ireland.
These data indicate an increasing and ageing population in Northern Ireland. The population in 2004 was 1,710,322, a 4.6% increase on the 1993 population. Between these two years there was a decrease from 24.1% to 20.9% in the percentage of the population aged under 15 and an increase from 17.2% to 18.4% in the percentage of the population aged 60 and over. (Fig. 1.1)
Figure 1.1: Male and female population by age group: 1993 & 2004 (a) 1993 (b) 2004
85+ 85+ Males Males 80-84 80-84 Females Females 75-79 75-79 70-74 70-74 65-69 65-69 60-64 60-64 55-59 55-59 50-54 50-54 45-49 45-49 40-44 40-44 35-39 35-39 30-34 30-34 25-29 25-29 20-24 20-24 15-19 15-19 10-14 10-14 5-9 5-9 0-4 0-4
80,000 60,000 40,000 20,000 0 20,000 40,000 60,000 80,000 80,000 60,000 40,000 20,000 0 20,000 40,000 60,000 80,000 Population Population Source: NISRA (2006)
2
Introduction
1.3: Statistical Methods Incidence and mortality For each cancer site reported on, the number of newly diagnosed cases (incidence) and number of deaths (mortality) that occurred annually between 1993 and 2004 are presented. However, given that the risk of getting cancer increases greatly with age and that the age distribution of the Northern Ireland population changes over time, trends in cancer incidence and mortality are investigated using age-standardised rates. Age-standardised incidence/mortality rates refer to the number of cancer cases/deaths per 100,000 persons occurring in the population if the population possessed the same age structure as a "standard" population. The European standard population, used in this report, is used throughout the EU and removes the effect that the ageing of the Northern Ireland population has on cancer trends and allows accurate comparisons of cancer rates between EU countries.
The trends in cancer rates are investigated using a log-linear model to fit the available data. The JoinPoint program developed by the US National Cancer Institute11-12 is used to test for changes in trends during the period and to determine the point in time that any changes may have occurred. The percentage increase/decrease in the age-standardised rate each year (annual percentage change, APC) for each cancer site is calculated and tested for statistical significance.
See appendix 2 for full definitions of incidence and mortality statistics.
Survival Observed survival is the proportion of patients who survive a specified amount of time after the point that they are diagnosed with cancer. It is typically presented as the probability of a group of patients surviving a specified amount of time regardless of the cause of death. The observed survival of a group of patients is determined by first assessing whether each patient in the group is alive or dead at a certain date. This date is known as the censor date, while the alive or dead status of each patient at this time is known as the vital status. If a patient’s vital status is unknown at the censor date (e.g. if they have moved abroad) the censor date is changed to be the date that the patients’ vital status was last recorded. Such patients are referred to as being lost to follow up. The number of patients recorded as lost to follow up in Northern Ireland is small due to the use of the passive follow up method of data collection.
If the patient has been identified as Figure 1.2: Calculation of survival times for different patient scenarios having died between the date of diagnosis and the censor date the Date of observed survival time is calculated death as the difference, in days, between Survival time the exact date of diagnosis and the exact date of death as recorded by No date of the GRO. If however the patient is death Survival time recorded still alive at the censor date the survival time is the difference between the date of diagnosis and Date of death Date of diagnosis Date of the censor date. Such patients are Survival time known as “censored” patients and for this report the censor date is 31st Date lost December 2004. (Fig. 1.2) to follow up Survival time Censor Observed survival does not take the date 0 10 cause of death into account and deaths due to causes other than cancer may result in a lower survival rate for cancer patients than if deaths due to cancer only were considered. A relative survival rate compensates for this discrepancy by taking the ratio of the observed survival to the expected survival, which is the survival that patients would have experienced if they had not developed cancer. The expected survival is derived from life tables for years 1993 to 2004, produced by the Government Actuary Department13 (GAD), which are tabulated according to age and sex.
Northern Ireland Cancer Registry 3
Survival of cancer patients in Northern Ireland: 1993-2004
Relative survival rates are given for three diagnosis periods (1993-1996, 1997-2000 & 2001-2003). Depending upon the size of the patient groups and availability of data this analysis is conducted by sex, age, and stage at diagnosis. For some cancers, cell type (e.g. small cell and non-small cell lung cancer) or a more specific cancer site breakdown (e.g. colon and rectal cancers in addition to colorectal cancer as a whole) is included. Survival rates are presented at two yearly intervals for the number of years for which data exists provided that the number of cases remains large enough to support such analysis. Thus • 1yr, 3yr, 5yr and, for some cancers, 7yr survival rates are presented for 1993-1996; • 1yr, 3yr and 5yr survival rates are presented for 1997-2000; • 1yr survival rates are presented for 2001-2003.
Considerable interest exists in variations in survival rates in Northern Ireland with regard to deprivation and urban-rural factors. However, background mortality varies between these areas, thus a separate life table is required for each area to enable determination of relative survival estimates. These are determined for each deprivation quintile and settlement band using the same methodology as that used by GAD13 which uses deaths data from the GRO4 and population data from the 2001 Census9. Due to the small number of patients involved in such an analysis only the four main cancers are investigated.
Conditional survival, which is the survival of patients who have already survived a given length of time, is also investigated for the major cancer sites. These estimates are determined in the same manner as observed and relative survival with the exception that a point after the date of diagnosis is used as the starting point in the calculation of survival time. Thus for one-year conditional survival (i.e. the proportion of patients who have survived one-year who survive a further period of time), the starting point is exactly one year after the date of diagnosis.
All relative survival rates were calculated using an algorithm written in the STATA statistical package by Dr. Paul Dickman, which uses the Ederer II method14 to calculate expected survival.
Full definitions of survival statistics are given in appendix 2.
Period analysis The method of deriving survival results thus far described is known as cohort analysis and is the method widely used by cancer registries in survival analysis. One recognised disadvantage of using this method is that due to the lengthy follow up time required to derive five-year relative and observed survival, it is only possible to report on the survival experience of patients diagnosed 7-8 years in the past.
Period analysis was introduced in 1997 by Brenner & Gefeller15 as a method for obtaining more up-to-date estimates of survival which can complement those obtained by traditional methods. This approach involves using the year that patients survive to as opposed to the year that they are diagnosed with cancer. This method was further enhanced in 2004 by Brenner & Rachet16 to solve difficulties involving the amount of follow-up data available. This method, known as hybrid-period analysis, is based on period analysis but also uses data on the patients diagnosed in the year prior to the period under investigation. Thus survival data for patients diagnosed in 2001-2004 can be estimated using the hybrid-period approach by examining both the survival experience of patients who have survived to 2001-2003 and the survival experience of patients diagnosed in 2000. The hybrid-period approach is used in this report but is referred to as period analysis for simplicity.
Data exclusions All patients are included in the incidence and mortality calculations, however survival calculations are restricted to adults aged 15 to 99 at the time of diagnosis with patients aged 100 and over excluded due to problems with data quality and interpretation of the results17. Survival among children aged 0 to 14 is studied and presented separately (Chapter 29).
NICR has a low percentage of registrations that are first notified from death certificates, a measure of high coverage and good data quality as it indicates that complete sets of data are being received from hospitals
4
Introduction and other sources. Registrations made in this manner have their data further supplemented with GP records to obtain a date of diagnosis prior to death. Where this is not possible the date of diagnosis is deemed to be the same as the date of death and the survival time is thus zero. These registrations are known as death certificate only (DCO) registrations and are excluded from any survival analysis, as inclusion of these patients would bias survival rates downward. In total 2.4% of cases registered between 1993 and 2003 were excluded, with 21% of these exclusions being diagnosed with cancer via an autopsy only.
In situations where a patient has multiple tumours only the primary tumour diagnosed is included in the survival analysis. In the event that more than one tumour of different type is diagnosed on the same date, only the most serious tumour is included as this tumour is the more relevant with regard to survival time for that patient. The definition of tumour severity is based upon EUROCARE guidance18.
Interpretation of results Uncertainty exists in any quoted rates due to random fluctuations in the number of new cases of cancer and cancer deaths from year to year and from place to place. Incidence, mortality and survival rates in this report are thus all accompanied by 95% confidence intervals to indicate the range in which it is 95% confident that the true value is likely to fall. Rates made up of a small number of observations tend to be less stable and have large confidence intervals, which is of relevance when interpreting the results of low incidence cancers.
Rates for two different time periods or population groups are considered to differ only if the 95% confidence intervals for the two rates do not overlap. This is known as statistical significance and for such differences the p-value is provided. The p-value indicates the probability that any difference observed between two rates is not due to chance. Thus a p-value of 0.001 indicates a 99.9% probability that differences are genuine and not a result of random factors.
In scenarios where a population sub-group is small, survival estimates are considered unreliable. Survival rates based on less than 10 patients are thus excluded from tables but are included in survival curves.
Full definitions of confidence intervals and p-values are given in appendix 2.
1.4: Comparisons with Other Countries Relative survival rates are available from countries in the British Isles, Australia, New Zealand, Canada and the USA. Sources for data from these countries are given in table 1.1; however caution needs to be exercised when making comparisons between survival rates in Northern Ireland and these countries for a variety of reasons: • Survival rates in different countries use different diagnostic periods to those in this report. Given that survival rates change over time any differences observed between countries could be the result of differences in the time period being examined as opposed to regional variations. • In some cases survival rates from other countries only represent a fraction of the population, as the registries do not always cover the entire country. • Confidence intervals for survival rates from other countries are not always provided. In such an event it cannot be ascertained whether or not differences in survival between countries are statistically significant. • Different age structures exist in different countries. Given that survival is dependent upon age at diagnosis any differences in survival rates may be a factor of differences in the age distribution of the population.
More accurate comparisons of survival between European countries have been made by the EUROCARE study group by comparing age-standardised relative survival rates for patients diagnosed with cancer. Age- standardised survival rates are determined in the same manner as age-standardised incidence and mortality rates with the European standard cancer population for each cancer site being used as the standard population.
Northern Ireland Cancer Registry 5
Survival of cancer patients in Northern Ireland: 1993-2004
Table 1.1: Latest diagnosis period and source of five-year relative survival rates in other countries Diagnosis Population Country Source of data period covered Northern Ireland 1997-2000 100% Northern Ireland Cancer Registry (NICR) Scotland 1997-2001 100% Information Services Department, Scotland (ISD)19 England 1998-2001 100% Office of National Statistics (ONS)20 Wales 1995-1999 100% Welsh Cancer Intelligence & Surveillance Unit (WCISU)21 Republic of Ireland 1998-2000 100% National Cancer Registry, Ireland (NCRI)22 USA 1996-2002 26% National Cancer Institute, USA (NCI)23 Canada 1995-1997 100% Canadian Cancer Society (CCS)24 Australia 1992-1997 100% Australian Institute of Health and Welfare (AIHW)25 New Zealand 1994-1999 100% New Zealand Health Information Service (NZHIS)26
The EUROCARE-3 study conducted in 200327,28 investigated patients diagnosed with cancer in 1990-1994 with follow up to the end of 1999, while the EUROCARE-4 study conducted in 200729 investigated patients diagnosed with cancer in 1995-1999 with follow up to the end of 2003. Northern Ireland was not included in the EUROCARE-3 study due to the unavailability of reliable cancer incidence data prior to 1993; however Northern Ireland was included in the EUROCARE-4 study along with 22 other European countries including England, Wales, Scotland and Republic of Ireland. (Tab. 1.2)
Table 1.2: European countries covered by the EUROCARE-3&4 studies and population coverage by participating cancer registries Population coverage Population coverage Population coverage Country Eurocare Eurocare Country Eurocare Eurocare Country Eurocare Eurocare 3 4 3 4 3 4 N. Ireland N/A 100% Estonia 100% N/A Poland 6% 9% England 63% 100% Finland 100% 100% Portugal 11% 43% Scotland 100% 100% France 6% 17% Slovakia 100% N/A Wales 100% 100% Germany 3% 1% Slovenia 100% 100% Ireland N/A 100% Iceland 100% 100% Spain 15% 16% Austria 8% 100% Italy 15% 28% Sweden 100% 100% Belgium N/A 58% Malta 100% 100% Switzerland 12% 17% Czech Rep. 8% 8% Netherlands 24% 34% Denmark 100% 100% Norway 100% 100% N/A: Not included in EUROCARE study Source: EUROCARE-3 (2003) 27,28 ; EUROCARE-4 (2007)29
The results of the EUROCARE-4 study are presented in this report for each cancer site published by EUROCARE as of October 2007 (lung, breast, prostate, colorectal, ovary, Hodgkin’s disease, malignant melanoma). For the remaining cancer sites EUROCARE-3 is used as the basis for comparison, although given that Northern Ireland was not included in this study, the EUROCARE-3 results are compared with age-standardised relative survival rates for patients diagnosed in Northern Ireland during 1993-1996 which have been derived using the same methodology as used by EUROCARE.
Many of the European registries have 100% coverage of the population however a few, such as France, Germany and Spain, only cover a small proportion. Consequently, despite the large sample size, caution should be exercised when interpreting survival differences between Northern Ireland and these countries. (Tab. 1.2)
1.5: Further Information Further data from the Northern Ireland Cancer Registry is available from:
Northern Ireland Cancer Registry, Telephone: 028 9063 2573 Centre for Clinical and Population Sciences, Fax: 028 9024 8017 Mulhouse Building, e-mail: [email protected] Grosvenor Road, website: www.qub.ac.uk/nicr Belfast, BT12 6BJ
6
Cancer in Northern Ireland
02: CANCER IN NORTHERN IRELAND
Cancer is a common disease among the population that results from the breakdown in the normal growth of body cells. The development of cancer is a complex process beginning with alterations to the genes that regulate normal cell growth. These alterations can cause a cell to become cancerous and grow out of control forming a tumour, which can ultimately invade surrounding tissue and cause damage to vital organs in the body.
Whether or not a person develops cancer is Table 2.1: Lifestyle factors in Northern Ireland: 2005/06 primarily down to chance although certain factors % of population such as age, inheritance of particular genes or Lifestyle factor aged 16 and over certain lifestyle factors such as cigarette smoking, Male Female excessive alcohol consumption or poor diet can Cigarette smoking 25% 27% Excessive alcohol consumption (above increase the level of risk. A high percentage of the 23% 15% recommended levels) Northern Ireland population either regularly Obesity 25% 23% smoke, drink above the recommended alcohol No moderate physical activity lasting 22% 23% level, or are obese and thus have an elevated risk 20min at least once per week of developing cancer. (Tab. 2.1) Source: NISRA (2007)30
In Northern Ireland one in three of the population develops a cancer by the time they reach 75 years of age. Excluding the rarely fatal non-melanoma skin cancer (NMSC) the risk for both males and females is one in four. The risk of dying from cancer before the age of 75 is lower than that for developing cancer but varies by sex; among males the risk is one in seven while in females it is one in nine.
Cancer was responsible for approximately one quarter of all deaths occurring in Northern Ireland between 2000 and 2004. It was the second most common cause of death behind diseases of the circulatory system, which includes coronary heart disease and stroke. On its own, coronary heart disease made up 23% of all male and 18% of all female deaths (2000-2004) and was thus a slightly less common cause of death among both males and females than cancer4. (Fig. 2.1)
Figure 2.1: Common causes of death in Northern Ireland (All ages): 2000-2004 (a) Male (b) Female
External Other External Other causes 9% Malignant causes 11% Malignant 6% neoplasms 3% neoplasms Diseases of Diseases of 26% 24% the digestive the digestive system system 4% 4%
Diseases of Diseases of the respiratory the respiratory system system 14% 16% Diseases of Diseases of Coronory the nervous the nervous (Ischaemic) system and Coronory system and heart disease sense organs (Ischaemic) sense organs 18% 3% Other heart disease Other 3% diseases of 23% diseases of the circulatory the circulatory system 14.9% system 20.9% Source: GRO (2006) 4 2.1: Incidence and Mortality During the period from 1993 to 2004 there were 104,788 cases of cancer diagnosed in Northern Ireland, with 78,233 being cancers other than non-melanoma skin cancer (NMSC). Most of these tumours presented in a single person, however 7,478 of these were second tumours (3,202 excluding NMSC), 621 were third tumours (135 excluding NMSC) and 61 were fourth tumours (8 excluding NMSC). Overall 7.7% of cancer patients diagnosed in the 1993-2004 period had two or more separate tumours. This fell to 4.3% when NMSC is excluded. (Tab. 2.2)
Northern Ireland Cancer Registry 7
Survival of cancer patients in Northern Ireland: 1993-2004
Table 2.2: Multiple primary tumours affecting the same person: 1993-2004 Number of Including NMSC Excluding NMSC tumours per Patients Tumours Patients Tumours person Number % of total Number % of total Number % of total Number % of total 1 89,143 92.26% 89,143 85.07% 71,684 95.72% 71,684 91.63% 2 6,857 7.10% 13,714 13.09% 3,067 4.10% 6,134 7.84% 3 560 0.58% 1,680 1.60% 127 0.17% 381 0.49% 4 or more 61 0.06% 251 0.24% 8 0.01% 34 0.04%
Total 96,621 104,788 74,886 78,233
Excluding NMSC 49% of newly diagnosed cancer cases occurred in males during 1993-2004, with 3,180 cases diagnosed per year, compared to 3,340 female cases. The larger number of female cases was due to the larger and older female population with the rate of new cases per 100,000 persons being higher in males than females. The total number of cases increased between the start and end of this period by 702 from 6,320 in 1993 to 7,022 in 2004. The increase was greater in females, with an additional 403 cases, compared to the additional 299 cases in males. (Tab. 2.3)
Table 2.3: Cancer incidence and deaths by sex and year of diagnosis/death: 1993-2004 Year of MALE FEMALE ALL PERSONS Diagnosis Number Number Number Number Number Number Number Number Number /death of new of new of deaths of new of new of deaths of new of new of deaths cases cases excluding cases cases excluding cases cases excluding including excluding NMSC including excluding NMSC including excluding NMSC NMSC NMSC NMSC NMSC NMSC NMSC 1993 4,123 3,128 1,881 4,276 3,192 1,737 8,399 6,320 3,618 1994 4,163 3,109 1,849 4,153 3,118 1,755 8,316 6,227 3,604 1995 4,077 3,058 1,842 4,205 3,171 1,644 8,282 6,229 3,486 1996 4,238 3,157 1,840 4,419 3,258 1,682 8,657 6,415 3,522 1997 4,164 3,039 1,840 4,366 3,289 1,742 8,530 6,328 3,582 1998 4,234 3,126 1,920 4,394 3,323 1,731 8,628 6,449 3,651 1999 4,201 3,010 1,789 4,413 3,344 1,746 8,614 6,354 3,535 2000 4,287 3,121 1,757 4,442 3,397 1,790 8,729 6,518 3,547 2001 4,385 3,257 1,918 4,314 3,282 1,734 8,699 6,539 3,652 2002 4,586 3,297 1,898 4,598 3,507 1,753 9,184 6,804 3,651 2003 4,719 3,426 1,894 4,726 3,602 1,829 9,445 7,028 3,723 2004 4,643 3,427 1,926 4,662 3,595 1,808 9,305 7,022 3,734
Annual 4,318 3,180 1,863 4,414 3,340 1,746 8,732 6,519 3,609 average
Males made up 52% of the cancer deaths during the twelve-year period with an annual average of 1,863 male deaths and 1,746 female deaths (excluding NMSC). The number of deaths from cancer each year between 1993 and 2004 increased, but to a lesser degree than the number of new cases, with 3,734 deaths in 2004 compared to 3,618 in 1993, an increase of 116. The increase in the number of deaths was greater in females than males, with 71 additional female deaths compared to 45 additional male deaths. (Tab. 2.3)
2.2: Common Cancers Non-melanoma skin cancer made up 26.4% of all male and 24.3% of all female cancers between 1993 and 2004. Excluding this cancer type the most commonly diagnosed male cancers, in descending order, were prostate, lung and colorectal, while in females they were breast, colorectal and lung. During this period the same cancers (excluding NMSC) were the most common causes of cancer deaths but in a different order with lung cancer the most common cause of cancer death among males and breast cancer the most common cause of female cancer death. (Fig. 2.2 & 2.3)
8
Cancer in Northern Ireland
Figure 2.2: Common cancer cases diagnosed: 1993-2004 (a) Male (b) Female
Prostate Lung Breast 20.8% 12.9% 12.8% Colorectal 10.2%
Colorectal 11.3% Lung 7.6% Non- Stomach Non- Ovary melanoma 3.6% melanoma 4.0% skin cancer Bladder skin cancer NHL 26.4% 3.4% 24.3% 2.9% NHL Uterus 2.9% 2.8% Kidney Melanoma 2.4% 2.7% Oral Stomach 2.2% Cervix 2.2% Other Oesophagus Other 1.8% 20.0% 2.1% 20.6%
Figure 2.3: Common cancer deaths: 1993-2004 (a) Male (b) Female
Colorectal Prostate Colorectal 11.2% 11.9% Ovary 11.8% Stomach 6.0% 5.8% Lung 16.8% Pancreas Oesophagus 4.6% 4.9% Stomach 4.2% Pancreas NHL 4.2% Lung 3.3% NHL 26.6% Oesophagus 3.3% 3.2% Breast Bladder Leukaemia 17.3% 3.0% 2.3% Leukaemia Liver 2.8% 1.9% Kidney 2.5% Other Other 23.9% 28.6%
2.3: Age Distribution Cancer is more common with increasing age. In both males and females new cases during 1993-2004 peaked in the 70 to 74 age group while deaths due to cancer peaked in the 70 to 74 age group for males and 75 to 79 age group for females. The median age at diagnosis for males was 70, while for females the median age at diagnosis was 68. The median age at death for males was two years older than that at diagnosis at 72, while for females it was five years older at 73. (Fig. 2.4 & 2.5)
Figure 2.4: Age distribution of patients diagnosed with Figure 2.5: Age distribution of cancer deaths (excluding cancer (excluding NMSC): 1993-2004 NMSC): 1993-2004
8,000 4,500 Male Male Female Female 7,000 4,000
3,500 6,000
3,000 5,000
2,500 4,000 2,000
3,000 1,500
2,000 Number of cancer deaths 1,000 Number of cancers diagnosed cancers of Number
1,000 500
0 0 0 to 5 to 10 15 to 20 to 25 to 30 to 35 to 40 to 45 to 50 to 55 to 60 to 65 to 70 to 75 to 80 to 85 0 to 5 to 10 15 to 20 to 25 to 30 to 35 to 40 to 45 to 50 to 55 to 60 to 65 to 70 to 75 to 80 to 85 4 9 to14 19 24 29 34 39 44 49 54 59 64 69 74 79 84 and 4 9 to14 19 24 29 34 39 44 49 54 59 64 69 74 79 84 and over over Age Group Age Group
Northern Ireland Cancer Registry 9
Survival of cancer patients in Northern Ireland: 1993-2004
There were on average 49 new cases of cancer diagnosed annually in children (aged 0 to 14) and 12 childhood deaths between 1993 and 2004. This was a small proportion of the total number of cancers (excluding NMSC) registered (boys-0.8%; girls-0.6%) and of cancer deaths (boys-0.4%; girls-0.2%). Among young people aged 15 to 24 there were 61 new cases of cancer each year and 15 cancer deaths. This represented 1.0% and 0.9% of male and female cancers respectively and 0.5% and 0.3% of male and female cancer deaths.
A better measure of the effect of age on cancer diagnosis is provided by age-specific incidence rates. These were seen to increase for both sexes by increasing age with a maximum value of 3,416 cases per 100,000 males and 1,846 cases per 100,000 females, both in the 85 and over age group. The maximum age-specific mortality rate was also seen in the 85 and over age group with 2,941 deaths per 100,000 males and 1,605 deaths per 100,000 females. (Fig. 2.6 & 2.7)
Figure 2.6: Age specific incidence rates for all cancers Figure 2.7: Age specific mortality rates for all cancers (excluding NMSC): 1993-2004 (excluding NMSC): 1993-2004
4,000 3,500 Male Male Female Female 3,500 3,000
3,000 2,500
2,500 2,000
2,000
1,500 1,500
1,000 1,000 Age Specific Mortality Rate Age Specific Incidence Rate Incidence Specific Age
500 500
0 0 0 to 5 to 10 15 to 20 to 25 to 30 to 35 to 40 to 45 to 50 to 55 to 60 to 65 to 70 to 75 to 80 to 85 0 to 5 to 10 15 to 20 to 25 to 30 to 35 to 40 to 45 to 50 to 55 to 60 to 65 to 70 to 75 to 80 to 85 4 9 to14 19 24 29 34 39 44 49 54 59 64 69 74 79 84 and 4 9 to14 19 24 29 34 39 44 49 54 59 64 69 74 79 84 and over over Age Group Age Group
The majority of cancers were more common in older than younger persons. A few exceptions to this were testicular cancer, which during 1993-2004, had a median age at diagnosis of 34, Hodgkin’s disease, which had a median age at diagnosis of 40 among males and 36 among females, and cervical cancer, which had a median age at diagnosis of 47. Figure 2.8: Median age at diagnosis by sex and cancer site: 1993-2004
Females were 80 Male 75 usually diagnosed as 75 73 75 74 73 73 73 Female 71 71 71 71 72 70 7070 70 having cancer later 70 69 69 68 68 68 69 69 66 67 67 65 66 than males. Some 64 65 65 62 exceptions were 59 60 60 58 57 cancer of the thyroid, 55 56
Hodgkin’s disease, 50 50 and malignant 47 melanoma. The most 40 40 common female 36 34 cancer, breast cancer, had a 30 younger median age at diagnosis of 60 Median Age at Diagnosis 20 than prostate cancer, the most common 10 male cancer, which had a median age at 0
s e x d n a t y s L l x y a s r h g a n s a r e diagnosis of 73. (Fig. ti s i i i s r u ra n e i u m e c n o a e t s a rv ro ra m a a r H y n m g tu iv a u m l e m d ta e e e y o re v te N O r d e a c L L lo o r io d s T s h B n O a i a h e m e C c l la o i C T la B U L K k p to y n e r 2.8) d e u o R a th B P 's e s S M P o n M L e le s ki O p e g ti M d l o u H M
10
Cancer in Northern Ireland
2.4: Geographic Distribution Age-standardised incidence and deaths due to cancer in the two highly urban areas of Northern Ireland (Belfast metropolitan urban area and Derry urban area8) were higher than in Northern Ireland as a whole during 1993-2004. While incidence and deaths from cancer in small towns, villages and open countryside were lower than average, the levels of each in intermediate settlements and medium to large towns were similar to the levels in Northern Ireland as a whole. This pattern is likely linked with factors such as deprivation. (Fig. 2.9)
Focusing on deprivation, levels of new cancer cases and cancer deaths increased by increasing level of deprivation with the 20% most deprived areas in Northern Ireland having significantly higher levels of newly diagnosed cancer and deaths due to cancer compared to Northern Ireland as a whole and, in particular, the most affluent areas. (Fig. 2.9)
Table 2.4 illustrates the geographic distribution throughout Northern Ireland during 1993-2004 of newly diagnosed cancer cases and cancer deaths by Local Government District (LGD). Belfast LGD had the highest number of newly diagnosed cancers and cancer deaths each year due to its higher population. These values were higher than what would be expected if cancer cases and deaths were evenly distributed across Northern Ireland. Derry and Newry & Mourne District Councils also had higher than expected levels of newly diagnosed cancer and cancer deaths. Higher levels of cancer in these areas were driven by high incidence of lung cancer (in Belfast and Derry), stomach cancer (in Belfast and Newry & Mourne) and colorectal cancer (in Derry and Newry & Mourne). This is likely to be linked to higher levels of deprivation and the associated higher levels of tobacco use in these areas.
Table 2.4: Standardised incidence and mortality ratios for all cancers (excluding NMSC) by Local Government District: 1993-2004 Local Average Standardised Incidence Average Standardised Mortality Government number of Ratio number of Ratio District cases per year (95% CI) deaths per (95% CI) year Antrim 158 96.8 (92.5,101.2) 88 100.7 (94.6,106.8) Ards 276 92.6 (89.4,95.7) 158 95.7 (91.4,100.0) Armagh 194 97.6 (93.7,101.6) 103 94.5 (89.3,99.8) Ballymena 223 91.8 (88.3,95.2) 126 93.3 (88.6,98.1) Ballymoney 94 91.0 (85.7,96.3) 51 88.5 (81.5,95.6) Banbridge 145 95.4 (90.9,99.9) 74 88.2 (82.3,94.0) Belfast 1,294 109.7 (108.0,111.4) 775 116.0 (113.6,118.4) Carrickfergus 143 100.3 (95.6,105.1) 82 105.2 (98.6,111.8) Castlereagh 292 98.3 (95.1,101.6) 160 96.0 (91.7,100.3) Coleraine 224 99.1 (95.4,102.8) 122 96.3 (91.4,101.3) Cookstown 102 88.4 (83.5,93.4) 55 86.6 (80.0,93.2) Craigavon 289 98.1 (94.8,101.4) 150 93.4 (89.1,97.7) Derry 350 110.6 (107.2,113.9) 198 118.5 (113.8,123.3) Down 235 98.5 (94.9,102.1) 127 96.1 (91.3,101.0) Dungannon 167 96.9 (92.6,101.1) 87 92.0 (86.4,97.6) Fermanagh 221 95.9 (92.3,99.6) 120 92.4 (87.6,97.2) Larne 136 104.0 (98.9,109.0) 74 102.1 (95.3,108.8) Limavady 96 95.9 (90.3,101.4) 51 95.1 (87.5,102.6) Lisburn 366 95.5 (92.6,98.3) 193 92.6 (88.8,96.4) Magherafelt 129 95.3 (90.6,100.1) 68 91.3 (85.1,97.6) Moyle 69 103.3 (96.3,110.4) 36 95.7 (86.6,104.7) Newry & Mourne 317 106.5 (103.2,109.9) 175 108.4 (103.8,113.1) Newtownabbey 319 100.3 (97.2,103.5) 173 99.2 (94.9,103.4) North Down 335 95.5 (92.5,98.4) 179 89.4 (85.6,93.2) Omagh 153 91.4 (87.3,95.6) 77 83.0 (77.7,88.4) Strabane 127 95.9 (91.1,100.7) 70 97.7 (91.1,104.3) Unknown 65 38
Total 6,519 100.0 3,609 100.0 SIRs/SMRs in blue represent significantly lower or higher incidence or mortality than in Northern Ireland as a whole.
Northern Ireland Cancer Registry 11
Survival of cancer patients in Northern Ireland: 1993-2004
Figure 2.9: Standardised incidence and mortality ratios for all cancers (excluding NMSC) by settlement band and deprivation quintile: 1993-2004 (a) Settlement band (b) Deprivation quintile
Small village, hamlet and open Least Deprived countryside Village
Intermediate Quintile 4 settlement
Small town Quintile 3 Medium town Settlement Band Settlement
Large town Deprivation Quintile Quintile 2
Derry Urban Area
Incidence Belfast Incidence Most Deprived Metropolitan Mortality Mortality Urban Area
60 70 80 90 100 110 120 130 140 50 60 70 80 90 100 110 120 130 140 150 Lower Standardised Ratio Higher Lower Standardised Ratio Higher
12
All cancers excluding NMSC
03: ALL CANCERS (Excluding non-melanoma skin cancer) (C00-C97, ex. C44) KEY FACTS: • 3,306 male and 3,477 female cases per year between 2000 and 2004 with no significant change in male incidence rates between 1999 and 2004, or female incidence rates between 1993 and 2004; • 1,879 male and 1,783 female deaths annually during 2000-2004 with decreasing male (-1.3% p.a.) and female (-0.8% p.a.) mortality rates between 1993 and 2004; • Survival better in females than males (51.2% of females and 39.4% of males alive after five years), with five-year relative survival improving by 3.7% for males and females between 1993-1996 and 1997-2000; • Survival decreased with increasing age with improvement over time for those aged 15-64 and 65-99; • Survival varied significantly by cancer site, ranging from over 90% after five-years for testicular cancer and melanoma to less than 15% after one-year for liver and pancreatic cancer; • Estimates using period analysis suggest that five-year survival will improve further for patients diagnosed in 2001- 2004; • Survival worse than in Europe and USA and in England for males but better than in Scotland for females.
3.1: Incidence and Mortality Incidence Excluding non-melanoma skin cancer (NMSC) there were 3,306 male and 3,477 female cases of cancer diagnosed each year in 2000-2004. Despite the greater number of female cases, age-standardised rates were significantly higher in Table 3.1: Incidence and mortality: All cancers excluding NMSC (2000-2004) males than females. (Tab. 3.1) Incidence Mortality Male Female Male Female
Number of cases/deaths per year 3,306 3,477 1,879 1,783 Mortality Percentage of all cancers 73.1% 76.4% 99.6% 99.6% There was an annual Median age at diagnosis/death 70 68 72 73 Male to female ratio 1.0:1 - 1.1:1 - average of 1,879 male and Incidence to mortality ratio 1.8:1 2.0:1 - - 1,783 female deaths in Crude rate per 100,000 persons 398.9 400.6 226.7 205.4 2000-2004. Given the European age-standardised rate 402.2 346.9 226.5 158.8 higher number of female per 100,000 persons (95% CI) (396.1,408.4) (341.5,352.3) (221.9,231.1) (155.3,162.3) cases, the incidence to mortality ratio was lower among males than females (1.8:1 compared to 2.0:1); a crude indication that survival was lower among males. (Tab. 3.1)
Trends Male incidence rates (EASIR) decreased during 1993-1999 by 1.6% each year (p=0.002). This was followed by a period of no significant change in 1999-2004, although the actual number of cases rose by 86.9 per year. No significant change in female EASIRs occurred in 1993-2004, however, the annual number of cases increased by 40.6 per year due to the ageing of the population. (Fig. 3.1; App. 4&6)
Figure 3.1: Incidence and mortality trends: All cancers excluding NMSC (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
500 500
450 450
400 400
350 350
300 300
250 250 persons 200 persons 200
150 150
100 100
50 Male 50 Male Age standardised incidence per 100,000 rate Age standardised mortalityrate per 100,000 Female Female 0 0 199319941995199619971998199920002001200220032004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
Northern Ireland Cancer Registry 13
Survival of cancer patients in Northern Ireland: 1993-2004
During 1993-2004 there was a downward trend of 1.3% (p<0.001) and 0.8% per year (p=0.003) in male and female mortality rates (EASMR) respectively. However the actual number of deaths increased by a small amount; 4.6 deaths per year for males and 9.2 deaths per year for females. (Fig. 3.1; App. 5&6)
3.2: Relative Survival One-year relative survival from all cancers (excluding NMSC) was 65.1% for patients diagnosed in 2001- 2003 while five-year relative survival was 45.7% for patients diagnosed in 1997-2000. (Tab. 3.2)
Table 3.2: Relative survival from all cancers excluding NMSC by sex and period of diagnosis (1993-2003) Survival time and RELATIVE SURVIVAL (95% CI) period of diagnosis Males Females All persons ALL PATIENTS 1993-1996 55.5% (54.5%, 56.4%) 64.8% (64.0%, 65.7%) 60.3% (59.6%, 60.9%) 1-year 1997-2000 58.1% (57.1%, 59.0%) 67.0% (66.1%, 67.8%) 62.8% (62.1%, 63.4%) 2001-2003 61.6% (60.5%, 62.6%) 68.5% (67.5%, 69.5%) 65.1% (64.4%, 65.9%)
1993-1996 40.9% (39.9%, 41.9%) 52.0% (51.0%, 52.9%) 46.6% (45.9%, 47.3%) 3-year 1997-2000 43.8% (42.8%, 44.8%) 55.2% (54.3%, 56.2%) 49.8% (49.2%, 50.5%)
1993-1996 35.7% (34.6%, 36.7%) 47.5% (46.5%, 48.5%) 41.8% (41.1%, 42.5%) 5-year 1997-2000 39.4% (38.3%, 40.4%) 51.2% (50.2%, 52.2%) 45.7% (44.9%, 46.4%)
7-year 1993-1996 33.2% (32.1%, 34.3%) 45.1% (44.0%, 46.1%) 39.4% (38.6%, 40.1%)
PATIENTS SURVIVING AT LEAST ONE YEAR (ONE-YEAR CONDITIONAL SURVIVAL) 1993-1996 73.2% (71.9%, 74.5%) 79.7% (78.7%, 80.7%) 76.8% (76.0%, 77.6%) 3-year* 1997-2000 75.0% (73.8%, 76.2%) 82.1% (81.1%, 83.0%) 79.0% (78.3%, 79.8%)
1993-1996 63.3% (61.8%, 64.8%) 72.5% (71.3%, 73.7%) 68.5% (67.5%, 69.4%) 5-year* 1997-2000 67.0% (65.5%, 68.4%) 75.8% (74.7%, 76.9%) 72.0% (71.1%, 72.9%)
7-year* 1993-1996 58.6% (57.0%, 60.2%) 68.4% (67.1%, 69.7%) 64.1% (63.1%, 65.2%) * from diagnosis Sex Relative survival for females from cancer (excluding NMSC) was consistently higher than for males diagnosed during 1993-2003. (Tab. 3.2; Fig. 3.2)
One-year relative survival for patients diagnosed in 2001-2003 with cancer (excluding NMSC) was 61.6% for males compared to 68.5% for females (p<0.001). Five-year relative survival was 39.4% for males diagnosed in 1997-2000 compared to 51.2% of females. (Tab. 3.2; Fig. 3.2)
Figure 3.2: Relative survival from all cancers excluding Figure 3.3: Relative survival from all cancers excluding NMSC by sex and period of diagnosis (1993-2000) NMSC by period of diagnosis and whether or not patients survive at least one year (1993-2000) 100% 100%
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40%
Relative survival (%) 30% Relative survival (%) 30%
20% Male (93-96) 20% All (93-96) Female (93-96) Survived one-year (93-96) 10% Male (97-00) 10% All (97-00) Female (97-00) Survived one-year (97-00) 0% 0% 00 01 02 03 04 05 00 01 02 03 04 05 Time since diagnosis (years) Time since diagnosis (years)
14
All cancers excluding NMSC
Changes over time Relative survival from all cancers (excluding NMSC) continuously improved for both males and females diagnosed during 1993-2003. (Tab. 3.2; Fig. 3.2)
One-year relative survival was 61.6% for males diagnosed in 2001-2003 compared to 55.5% for males diagnosed in 1993-1996, a significant increase of 6.1% (p<0.001), while female one-year relative survival increased between 1993-1996 and 2001-2003 by 3.7% (p<0.001) from 64.8% to 68.5%. (Tab. 3.2; Fig. 3.2)
Five-year relative survival improved for males between 1993-1996 and 1997-2000 with an additional 3.7% of male patients surviving five-years from diagnosis (p<0.001). A similar increase was noted for females with a 3.7% increase in five-year relative survival for patients diagnosed in 1997-2000 compared with those diagnosed in 1993-1996 (p<0.001). (Tab. 3.2; Fig. 3.2)
Conditional survival Five-year relative survival from the date of diagnosis for the sub-group of patients who survived at least one-year from a diagnosis of cancer (excluding NMSC) was 72.0%, while seven-year survival was 64.1%. This conditional survival was significantly higher among females than males (p<0.001). (Tab. 3.2; Fig. 3.3)
Five-year relative survival for these patients improved between 1993-1996 and 1997-2000 by 3.7% (p<0.001) and 3.3% (p<0.001) for males and females respectively. (Tab. 3.2; Fig. 3.3)
Age For patients diagnosed with cancer (excluding NMSC) relative survival was better among those aged 15-64 than those aged 65-99 (p<0.001). (Tab. 3.3)
Five-year relative survival for both Table 3.3: Relative survival from all cancers excluding NMSC by age and period of diagnosis (1993-2003) age groups demonstrated improvement over time with 58.3% Survival time and RELATIVE SURVIVAL (95% CI) period of diagnosis Aged 15-64 Aged 65-99 of 15-64 year olds and 37.0% of 65- 1993-1996 72.9% (72.0%, 73.8%) 52.1% (51.2%, 53.0%) 99 year olds diagnosed in 1997- 1-year 1997-2000 76.2% (75.3%, 77.0%) 53.8% (52.9%, 54.7%) 2000 surviving five-years compared 2001-2003 78.5% (77.5%, 79.4%) 56.2% (55.2%, 57.1%) to 54.2% of 15-64 year olds and 33.5% of 65-99 year olds diagnosed 1993-1996 54.2% (53.1%, 55.3%) 33.5% (32.5%, 34.4%) 5-year in 1993-1996. (Tab. 3.3) 1997-2000 58.3% (57.3%, 59.3%) 37.0% (36.0%, 38.0%)
For patients diagnosed in 1997-2000 relative survival decreased among females as age increased (p<0.002) with five-year relative survival ranging from 77.5% among younger (aged 15-44) to 36.1% among older (aged 75 and over) females. Survival among males aged 15-44 was also better than in older age groups. (Fig. 3.4; App. 8)
Figure 3.4: Relative survival from all cancers excluding NMSC by age, sex and period of diagnosis (1993-2003) (a) One-year (b) Five-year
100% 1993-1996 1997-2000 2001-2003 100% 1993-1996 1997-2000
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40%
Relative survival (%) 30% Relative survival (%) 30%
20% 20%
10% 10%
0% 0% Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female 15-44 45-54 55-64 65-74 75+ 15-44 45-54 55-64 65-74 75+ Sex and Age Sex and Age
Northern Ireland Cancer Registry 15
Survival of cancer patients in Northern Ireland: 1993-2004
Five-year relative survival among males and females aged 55-64 improved between 1993-1996 and 1997- 2000 by 6.0% (p=0.006) and 5.6% (p=0.009) respectively. Improvements in five-year relative survival also occurred for males aged 65-74 (5.3%; p=0.003) and for females aged 75-99 (4.4%; p=0.037). (Fig. 3.4; App. 8)
Cancer site Relative survival depended greatly upon cancer site with survival ranging from over 90% after five-years for testicular cancer to less than 15% after one-year for pancreatic cancer. Survival was highest among male cancer patients with testicular cancer, malignant melanoma, prostate cancer and Hodgkin’s disease and female patients with malignant melanoma, breast cancer, Hodgkin’s disease and cancer of the uterus. The poorest prognosis was among patients with mesothelioma, lung, liver and pancreatic cancer. (Fig. 3.5)
Figure 3.5: Relative survival from all cancers excluding NMSC by sex and cancer site (a) One-year survival (patients diagnosed in 2000-2003) (b) Five-year survival (patients diagnosed in 1996-2000)
Testis Testis
Melanoma Melanoma
Breast Breast
Prostate Hodgkin's disease
Hodgkin's disease Uterus
Uterus Cervix
Cervix Larynx
Oral Prostate
Larynx Colon
Rectum Non-Hodgkin's lymphoma
Colon Rectum
Non-Hodgkin's lymphoma Kidney
Multiple myeloma Bladder
Ovary Ovary
Kidney Oral
Bladder Multiple myeloma
Leukaemia Leukaemia
Oesophagus Brain
Brain Stomach
Stomach Oesophagus
Lung Mesothelioma
Liver Lung Male Male Mesothelioma Liver Female Female Pancreas Pancreas
0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100% One-year relative survival (%) Five-year relative survival (%)
3.3: Observed Survival One-year observed survival (which takes into account deaths from all causes and therefore is lower than relative survival) from all cancers excluding NMSC was 59.3% for male and 66.7% for female patients diagnosed between 2001 and 2003. Five-year observed survival was 31.7% for male and 45.1% for female patients diagnosed between 1997 and 2000. (Tab. 3.4)
Table 3.4: Observed survival from all cancers excluding NMSC by sex and period of diagnosis (1993-2003) Survival time and OBSERVED SURVIVAL (95% CI) period of diagnosis Males Females All persons 1993-1996 53.0% (52.0%, 53.9%) 63.1% (62.2%, 63.9%) 58.1% (57.5%, 58.7%) 1-year 1997-2000 55.6% (54.7%, 56.5%) 65.2% (64.4%, 66.0%) 60.6% (60.0%, 61.3%) 2001-2003 59.3% (58.3%, 60.3%) 66.7% (65.8%, 67.7%) 63.1% (62.4%, 63.8%)
1993-1996 28.1% (27.3%, 28.9%) 41.6% (40.7%, 42.5%) 35.0% (34.4%, 35.6%) 5-year 1997-2000 31.7% (30.8%, 32.5%) 45.1% (44.2%, 46.0%) 38.7% (38.1%, 39.3%)
16
All cancers excluding NMSC
3.4: Period Analysis Figure 3.6: Estimated relative survival (period analysis) from all cancers Traditional methods for producing five- excluding NMSC for patients diagnosed in 2001-2004 compared with year relative survival rates (cohort actual relative survival (cohort analysis) for patients diagnosed in 1997- analysis) require five-years worth of 2000 follow up data and do not reflect more 100% recent survival experience. More up to 90% date survival rates can however be 80% estimated using period analysis. 70%
Five-year survival from all cancers 60% (excluding NMSC) for males diagnosed 50% in 2001-2004 derived using this approach was 42.8% while for females 40% Relative survival (%) survival Relative it was 53.1%. While not directly 30% comparable with results from traditional methods, these estimates represent an 20% Male (97-00: Cohort analysis) Female (97-00: Cohort analysis) improvement in survival for male 10% Male (01-04: Period analysis) patients compared to those diagnosed Female (01-04: Period analysis) 0% in 1997-2000. Improvements in female 00 01 02 03 04 05 survival were not significant, but only Time since diagnosis (years) by a slight margin. (Fig. 3.6; App. 7)
3.5: International Comparisons EUROCARE-4 study Comparisons with countries included in the EUROCARE-4 study illustrates that Northern Ireland had a lower age-standardised relative survival rate for patients diagnosed in 1995-1999 than Europe for males
Figure 3.7:Comparison of five-year age-standardised relative survival from all cancers excluding NMSC with other European countries (a) Male (b) Female
Northern Ireland Northern Ireland Austria Austria Belgium Belgium Czech Czech Denmark Denmark Finland Finland France France Germany Germany Iceland Iceland Ireland Ireland Italy Italy Malta Malta Netherlands Netherlands Norway Norway European country European country European Poland Poland Portugal Portugal Slovenia Slovenia Spain Spain Sweden Sweden Switzerland Switzerland UK_England UK_England UK_Scotland UK_Scotland UK_Wales UK_Wales Europe Europe
0% 10% 20% 30% 40% 50% 60% 70% 0% 10% 20% 30% 40% 50% 60% 70% Five-year relative survival (%) Five-year relative survival (%)
Source:EUROCARE-4 (2007)29
Northern Ireland Cancer Registry 17
Survival of cancer patients in Northern Ireland: 1993-2004 and females. For males survival was significantly lower than in England, Ireland and Wales, but was similar to that in Scotland, while for females survival was higher than in Scotland, was similar to England and Ireland but was lower than in Wales. Compared to the other European countries survival in Northern Ireland was lower than most but was higher than in Poland and was similar to that in the Czech Republic. (Fig. 3.7)
Other countries Male and female five-year relative survival rates for all Table 3.5: Five-year relative survival from all cancers excluding NMSC for various countries cancers (excluding NMSC) in Northern Ireland during Period of the late 1990s were considerably lower than in Country Male Female diagnosis Australia, Canada and the USA. However these Northern Ireland 1997-2000 39.4% 51.2% differences are likely to be due to a different mix of USA 1996-2002 65.3% 64.8% cancers present in each country than any major Canada 1995-1997 57.0% 61.5% difference in other factors effecting survival probability. Australia 1992-1997 56.8% 63.4% (Tab. 3.5) New Zealand 1994-1999 - -
3.6: Summary and Discussion Rates of new cases of cancer in Northern Ireland are fairly static although the actual number of cases is increasing due to the ageing of the population. Despite this as survival continues to improve mortality rates are decreasing in Northern Ireland along with other countries in the UK31,32.
Cancer can develop as a result of factors related to environment, lifestyle, and heredity. While our current understanding of the causes of cancer is incomplete, many risk factors that increase the possibility of getting cancer have been identified. These include age, history of cancer in the family, tobacco use, alcohol consumption, lack of balanced diet, lack of physical activity, obesity, exposure to ultraviolet radiation from sunshine or sunbeds, exposure to certain chemicals and gases such as asbestos, benzene or radon gas, exposure to ionising radiation, infections such as human papillomavirus (HPV), treatments such as exposure to oestrogen through Hormone Replacement Therapy (HRT), late or lack of reproduction in females and lack of breast feeding in females. While most people with a particular risk factor for cancer will not contract the disease, the possibility of developing cancer can increase as exposure to a risk factor increases.
Tobacco is a major risk factor in the development of many cancers (e.g. lung, larynx, oesophagus, stomach, pancreas, kidney and bladder). The introduction of smoke-free workplaces in 2007 should reduce exposure to tobacco smoke and thus levels of these cancers. The population must also strive to increase fruit and vegetable consumption, maintain a healthy body weight and take regular exercise to reduce their cancer risk.
Upon developing cancer, survival probability depends upon sex and age but will vary greatly depending upon the type of cancer. Survival is improving over time but further improvements are possible as evidenced by the higher survival rates in other countries. Survival from cancer is improved when the cancer is detected early. The population should be encouraged to use screening services when invited, remain vigilant and seek expert advice about new symptoms and/or changes in their bodies which may indicate cancer.
18
Cancer of the lip, oral cavity & pharynx
04: CANCER OF THE LIP, ORAL CAVITY & PHARYNX (C00-C14) KEY FACTS: • 90 male and 44 female cases per year between 2000 and 2004 with decreasing male (-3.0% p.a.) and no significant change in female incidence rates between 1993 and 2004; • 31 male and 18 female deaths per year between 2000 and 2004 with decreasing male (-2.6% p.a.) and no significant change in female mortality rates between 1993 and 2004; • Survival similar in males and females: 49.3% of males and 39.1% of females alive after five years, with one-year survival having improved for females from 64.6% to 83.9% between 1997-2000 and 2001-2003; • Survival better for those aged 15-64 than for those aged 65 and over; • Survival worse than in USA and Canada.
4.1: Incidence and Mortality Incidence Cancer of the lip, oral cavity and pharynx made up 2.2% of male and 1.1% of female cancers between 2000 and 2004. It was more common among males than females with 90 male and 44 female cases each year making it the eleventh most Table 4.1: Incidence and mortality: Cancer of the lip, oral cavity & pharynx common male cancer and (2000-2004) eighteenth most common female Incidence Mortality cancer. (Tab. 4.1) Male Female Male Female Number of cases/deaths per year 90 44 31 18 Mortality Percentage of all cancers 2.2% 1.1% 1.7% 1.1% Rank 11 18 14 17 There were 31 male and 18 Median age at diagnosis/death 63 66 67 71 female deaths per year during Male to female ratio 2.0:1 - 1.8:1 - 2000 to 2004 making up 1.7% of Incidence to mortality ratio 2.9:1 2.5:1 - - male and 1.1% of female cancer Crude rate per 100,000 persons 10.8 5.1 3.8 2.0 deaths. It was the fourteenth European age-standardised rate 11.3 4.4 3.9 1.7 commonest cause of male per 100,000 persons (95% CI) (10.2,12.3) (3.8,5.0) (3.3,4.5) (1.3,2.1) cancer death and seventeenth among females. (Tab. 4.1)
Trends Male incidence rates (EASIR) for oral cancer fell in 1993-2004 by 3.0% each year (p=0.002) corresponding to a decrease of 1.6 cases per year. Female EASIRs remained unchanged, although the number of cases decreased by an average of 0.6 per year. (Fig. 4.1; App. 4&6)
Male mortality rates (EASMR) for cancer of the lip, oral cavity and pharynx fell during 1993-2004 by 2.6% each year (p=0.049) while female EASMRs exhibited no significant trend (p>0.05). Variations in the actual number of deaths for both sexes were small over the twelve-year period. (Fig. 4.1; App. 5&6)
Figure 4.1: Incidence and mortality trends: Cancer of the lip, oral cavity & pharynx (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
20 20 Male Male
18 Female 18 Female
16 16
14 14
12 12
10 10 persons persons 8 8
6 6
4 4
2 per 100,000 rate standardised mortality Age 2 Age standardised incidence rate per 100,000
0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
Northern Ireland Cancer Registry 19
Survival of cancer patients in Northern Ireland: 1993-2004
4.2: Relative Survival Relative survival from oral cancer was average with 78.5% of patients diagnosed between 2001 and 2003 surviving one-year and 45.7% diagnosed between 1997 and 2000 surviving five years. (Tab. 4.2)
Table 4.2: Relative survival from cancer of the lip, oral cavity & pharynx by sex and period of diagnosis (1993-2003) Survival time and RELATIVE SURVIVAL (95% CI) period of diagnosis Males Females All persons ALL PATIENTS 1993-1996 70.9% (65.9%, 75.8%) 74.9% (68.2%, 81.6%) 72.2% (68.2%, 76.2%) 1-year 1997-2000 72.7% (67.6%, 77.9%) 64.6% (57.1%, 72.0%) 69.9% (65.7%, 74.2%) 2001-2003 75.7% (69.9%, 81.5%) 83.9% (76.5%, 91.3%) 78.5% (73.9%, 83.1%)
1993-1996 54.3% (48.6%, 60.1%) 56.7% (48.8%, 64.7%) 55.1% (50.5%, 59.8%) 3-year 1997-2000 54.9% (48.9%, 60.8%) 43.7% (35.7%, 51.7%) 51.0% (46.2%, 55.8%)
1993-1996 49.3% (43.2%, 55.4%) 50.9% (42.4%, 59.3%) 49.8% (44.8%, 54.7%) 5-year 1997-2000 49.3% (42.9%, 55.6%) 39.1% (30.8%, 47.3%) 45.7% (40.7%, 50.8%)
Sex Figure 4.2: Relative survival from cancer of the lip, oral cavity & pharynx Relative survival from cancer of the by sex and period of diagnosis (1993-2000) lip, oral cavity & pharynx was similar 100% for males and females. For example, 90% 49.3% of males diagnosed in 1997- 80% 2000 were alive after five-years compared to 39.1% of females; a 70% difference of 10.2% which was not 60% statistically significant (p>0.05). (Tab. 4.2; Fig. 4.2) 50% 40%
Changes over time Relative survival (%) 30%
One-year relative survival for female 20% Male (93-96) patients diagnosed with cancer of the Female (93-96) 10% Male (97-00) lip, oral cavity & pharynx improved Female (97-00) during 1997-2003 with 64.6% of 0% 00 01 02 03 04 05 females diagnosed between 1997- Time since diagnosis (years) 2000 surviving one year compared to 83.9% of females diagnosed between 2001-2003; a statistically significant difference of 19.3% (p=0.011).
There were no statistically significant changes in male one, three or five-year relative survival or in female three or five-year relative survival for patients diagnosed with this cancer between 1993 and 2003 (p>0.05). (Tab. 4.2; Fig. 4.2)
Age One and five-year relative survival for those aged 15-64 diagnosed with cancer of the lip, oral cavity & pharynx in 1997-2000 was better than for those aged 65-99 Table 4.3: Relative survival from cancer of the lip, oral cavity & pharynx by age (p=0.009). Differences between and period of diagnosis (1993-2003) these age groups for the 1993- Survival time and RELATIVE SURVIVAL (95% CI) 1996 and 2001-2003 periods period of diagnosis Aged 15-64 Aged 65-99 were not significant (p<0.05). 1993-1996 77.1% (71.6%, 82.5%) 68.4% (62.8%, 74.0%) There were no significant 1-year 1997-2000 78.2% (72.8%, 83.7%) 62.8% (56.5%, 69.0%) improvements over time for 2001-2003 83.3% (77.7%, 89.0%) 73.5% (66.3%, 80.7%) either age group. (Tab. 4.3) 1993-1996 53.5% (46.9%, 60.1%) 47.1% (39.8%, 54.3%) 5-year 1997-2000 56.2% (49.3%, 63.0%) 36.4% (29.2%, 43.6%)
20
Cancer of the lip, oral cavity & pharynx
Figure 4.3: Relative survival from cancer of the lip, oral cavity & pharynx by age, sex and period of diagnosis (1993-2003) (a) One-year (b) Five-year
100% 1993-1996 1997-2000 2001-2003 100% 1993-1996 1997-2000
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40% Relative survival (%) Relative survival (%) 30% 30%
20% 20%
10% 10%
0% 0% Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female 15-44 45-54 55-64 65-74 75+ 15-44 45-54 55-64 65-74 75+ Sex and Age Sex and Age Note: Missing entries refer to less than 10 persons in that age/sex group For patients diagnosed in 1993-1996 five-year relative survival was better among males aged 15-44 compared with those aged over 44 (p=0.039). There were no statistically significant changes in relative survival over time for individual male or female age groups during 1993-2003. (Fig. 4.3; App. 8)
4.3: International Comparisons There is considerable variation in the manner in Table 4.4: Five-year relative survival from cancer of the which most cancer registries produce survival rates lip, oral cavity & pharynx for various countries Period of for oral cancer with different organisations including Country Male Female different parts of the head and neck. For example the diagnosis EUROCARE-3 study produces survival estimates on Northern Ireland 1997-2000 49.3% 39.1% USA 1996-2002 57.6% 61.3% the head and neck excluding the salivary glands. As Canada 1995-1997 61.0% 63.0% a consequence only a few international comparisons Australia 1992-1997 - - are possible for this cancer. New Zealand 1994-1999 - -
In the USA five-year relative survival was 57.6% for males and 61.3% for females diagnosed between 1996 and 2002 while in Canada five-year relative survival was 61.0% for males and 63.0% for females diagnosed between 1995 and 1997. Both were significantly higher than the five-year relative survival rates in Northern Ireland for persons diagnosed in 1997-2000. (Tab. 4.4)
4.4: Summary and Discussion Tobacco and excessive alcohol consumption are linked with cancers of the lip, oral cavity and pharynx33. Diet can also affect the risk of developing oral cancers with a deficiency in zinc or Vitamin A increasing the risk and a diet high in fresh fruit and vegetables reducing the risk33. A weakened immune system, caused for example by medicines taken after an organ transplant, can increase the risk of developing oral cancer33 and a possible link with human papillomavirus (HPV) has recently been reported34 although this remains to be proven. Exposure to UV radiation from sunshine or sunbeds is also known to be a risk factor for cancer of the lip33 while regular exposure to certain chemicals such as wood dust, paint fumes or soot increase the risk of cancer of the mouth, nasal cavity or pharynx33.
The falling levels of oral cancer in Northern Ireland are likely due to a reduction in the use of tobacco with further reductions possible if tobacco use was further curtailed. Survival in Northern Ireland from the disease is average with no evidence of changes over time.
Northern Ireland Cancer Registry 21
Survival of cancer patients in Northern Ireland: 1993-2004
05: OESOPHAGEAL CANCER (C15) KEY FACTS: • 92 male and 59 female cases per year between 2000 and 2004 with no significant change in male or female incidence rates between 1993 and 2004; • 97 male and 56 female deaths per year between 2000 and 2004 with no significant change in male or female mortality rates between 1993 and 2004; • Survival similar in males and females: 13.2% of males and 12.3% of females alive after five years, with five-year survival having improved for males from 5.7% to 13.2% between 1993-1996 and 1997-2000; • One-year survival better for 15-64 year olds than 65-99 years olds but no significant variation in five-year survival; • Similar five-year survival to the rest of the UK, North America and Europe.
5.1: Incidence and Mortality Incidence In 2000-2004 there were 92 male oesophageal cancer cases per year, representing 2.0% of male cancers making it the ninth commonest male cancer. This cancer was less common among females with 59 cases diagnosed annually. It was the Table 5.1: Incidence and mortality: Oesophageal cancer (2000-2004) fourteenth commonest female cancer making up 1.3% of Incidence Mortality Male Female Male Female female cancer cases. (Tab. 5.1) Number of cases/deaths per year 92 59 97 56 Percentage of all cancers 2.0% 1.3% 5.1% 3.1% Mortality Rank 9 14 5 8 Median age at diagnosis/death 69 75 69 76 There were 97 newly diagnosed Male to female ratio 1.6:1 - 1.7:1 - male oesophageal cancer Incidence to mortality ratio 1.0:1 1.1:1 - - deaths per year in 2000 -2004. Crude rate per 100,000 persons 11.1 6.8 11.7 6.4 This represented 5.1% of cancer European age-standardised rate 11.4 5.0 11.8 4.5 deaths with this cancer the fifth per 100,000 persons (95% CI) (10.3,12.4) (4.4,5.6) (10.7,12.8) (4.0,5.1) commonest male cancer death. Among females there were 56 deaths per year from oesophageal cancer between 2000 and 2004. It was the eighth commonest female cancer death making up 3.1% of female cancer deaths. (Tab. 5.1)
Trends No significant trends in male or female incidence rates (EASIR) existed for this cancer during 1993-2004 (p>0.05). The number of male and female cases was also fairly static over time. (Fig. 5.1; App. 4&6)
Mortality rates (EASMR) were also static during 1993-2004 (p>0.05), however the number of deaths increased annually among males and females by 1.9 and 0.9 respectively with the exception of the 2002- 2004 period which saw a drop of 2.5 deaths per year among females. (Fig. 5.1; App. 5&6)
Figure 5.1: Incidence and mortality trends: Oesophageal cancer (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
18 18
16 16
14 14
12 12
10 10
8 8 persons persons
6 6
4 4
2 Male 2 Male Age standardised mortality rateper 100,000 Age standardised incidence rate per 100,000 Female Female 0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
22
Oesophageal cancer
5.2: Relative Survival Relative survival from cancer of the oesophagus was poor with 35.0% of patients diagnosed in 2001-2003 surviving one-year and 12.8% of patients diagnosed in 1997-2000 surviving five years. (Tab. 5.2)
Table 5.2: Relative survival from oesophageal cancer by sex and period of diagnosis (1993-2003) Survival time and RELATIVE SURVIVAL (95% CI) period of diagnosis Males Females All persons ALL PATIENTS 1993-1996 27.2% (22.3%, 32.1%) 30.9% (24.3%, 37.4%) 28.6% (24.7%, 32.5%) 1-year 1997-2000 35.6% (30.4%, 40.8%) 29.4% (23.5%, 35.3%) 33.0% (29.1%, 37.0%) 2001-2003 33.0% (27.3%, 38.8%) 38.3% (30.6%, 46.0%) 35.0% (30.4%, 39.6%)
1993-1996 10.0% (6.6%, 13.4%) 16.1% (10.7%, 21.6%) 12.3% (9.3%, 15.2%) 3-year 1997-2000 15.4% (11.4%, 19.5%) 13.7% (9.0%, 18.3%) 14.7% (11.6%, 17.8%)
1993-1996 5.7% (3.0%, 8.4%) 14.4% (9.0%, 19.8%) 8.9% (6.3%, 11.6%) 5-year 1997-2000 13.2% (9.3%, 17.2%) 12.3% (7.6%, 17.0%) 12.8% (9.8%, 15.8%)
PATIENTS SURVIVING AT LEAST ONE YEAR (ONE-YEAR CONDITIONAL SURVIVAL) 1993-1996 36.4% (25.9%, 47.0%) 51.9% (38.3%, 65.5%) 42.7% (34.3%, 51.2%) 3-year* 1997-2000 43.2% (33.8%, 52.6%) 46.2% (33.4%, 58.9%) 44.2% (36.7%, 51.8%)
1993-1996 22.0% (12.6%, 31.4%) 45.9% (31.7%, 60.1%) 31.7% (23.4%, 39.9%) 5-year* 1997-2000 36.8% (27.3%, 46.4%) 41.3% (27.8%, 54.7%) 38.4% (30.6%, 46.2%) * from diagnosis Sex For patients diagnosed in 2001-2003 and 1997-2000 relative survival from oesophageal cancer was similar for males and females. In particular five-year relative survival for males diagnosed in 1997-2000 was 13.2% compared to 12.3% for females; a difference of only 0.9% (p>0.05). This differs from the situation for patients diagnosed in 1993-1996 when a difference of 8.7% existed between five-year relative survival for males and females (p=0.036). (Tab. 5.2; Fig.5.2)
Changes over time There was an improvement in male five-year relative survival for patients diagnosed with cancer of the oesophagus during 1993-2000 with 5.7% of males diagnosed between 1993-1996 surviving five years compared to 13.2% of males diagnosed between 1997-2000 (p=0.027). (Tab. 5.2; Fig. 5.2)
There were no statistically significant changes in female one or five-year relative survival or in male one- year relative survival for patients diagnosed between 1993 and 2003 (p>0.05). (Tab. 5.2; Fig. 5.2)
Figure 5.2: Relative survival from oesophageal cancer by Figure 5.3: Relative survival from oesophageal cancer by sex and period of diagnosis (1993-2000) period of diagnosis and whether or not patients survive at least one year (1993-2000) 100% 100% Male (93-96) All (93-96) 90% Female (93-96) 90% Survived one-year (93-96) Male (97-00) All (97-00) 80% Female (97-00) 80% Survived one-year (97-00)
70% 70%
60% 60%
50% 50%
40% 40%
Relative survival (%) 30% Relative survival (%) 30%
20% 20%
10% 10%
0% 0% 00 01 02 03 04 05 00 01 02 03 04 05 Time since diagnosis (years) Time since diagnosis (years)
Northern Ireland Cancer Registry 23
Survival of cancer patients in Northern Ireland: 1993-2004
Conditional survival Five-year relative survival for patients who survived one-year from diagnosis and were diagnosed in 1997- 2000 was 38.4%. This conditional survival rate did not vary by sex during this period; however as with all patients this proportion was worse for males than for females diagnosed in 1993-1996 (p=0.048). There were no significant changes over time for conditional survival. (Tab. 5.2; Fig. 5.3)
Age One-year relative survival for those Table 5.3: Relative survival from oesophageal cancer by age and period of aged 15-64 diagnosed with diagnosis (1993-2003) oesophageal cancer in 1993-1996 Survival time and RELATIVE SURVIVAL (95% CI) and 2001-2003 was better than for period of diagnosis Aged 15-64 Aged 65-99 those aged 65-99 (p=0.04). 1993-1996 37.0% (29.7%, 44.3%) 24.6% (20.0%, 29.1%) 1-year 1997-2000 40.6% (33.6%, 47.5%) 29.2% (24.5%, 33.9%) Differences in five-year relative 2001-2003 47.8% (39.3%, 56.2%) 29.1% (23.7%, 34.4%) survival for patients diagnosed 1993-1996 10.4% (5.7%, 15.1%) 8.3% (5.0%, 11.6%) during 1993-2000 were not 5-year 1997-2000 17.3% (11.7%, 22.8%) 10.6% (7.0%, 14.2%) statistically significant (p<0.05). There were also no significant improvements over time for either age group. (Tab. 5.3)
5.3: Observed Survival One-year observed survival (which takes into account deaths from all causes and therefore is lower than relative survival) from oesophageal cancer was 31.9% for male and 36.8% for female patients diagnosed between 2001 and 2003. Five-year observed survival was 11.3% for male and 9.8% for female patients diagnosed between 1997 and 2000. (Tab. 5.4)
Table 5.4: Observed survival from oesophageal cancer by sex and period of diagnosis (1993-2003) Survival time and OBSERVED SURVIVAL (95% CI) period of diagnosis Males Females All persons 1993-1996 26.2% (21.5%, 30.9%) 29.6% (23.3%, 35.8%) 27.5% (23.7%, 31.2%) 1-year 1997-2000 34.3% (29.3%, 39.3%) 28.1% (22.4%, 33.8%) 31.7% (28.0%, 35.5%) 2001-2003 31.9% (26.3%, 37.4%) 36.8% (29.4%, 44.2%) 33.7% (29.3%, 38.2%)
1993-1996 4.8% (2.5%, 7.0%) 11.8% (7.4%, 16.3%) 7.4% (5.2%, 9.6%) 5-year 1997-2000 11.3% (7.9%, 14.6%) 9.8% (6.1%, 13.6%) 10.7% (8.2%, 13.2%)
5.4: Period Analysis Figure 5.4: Estimated relative survival (period analysis) from Five-year survival from oesophageal oesophageal cancer for patients diagnosed in 2001-2004 compared with actual relative survival (cohort analysis) for patients diagnosed in cancer for patients diagnosed in 2001- 1997-2000. 2004 derived using the period analysis 100% approach, in order to reflect more Male (97-00: Cohort analysis) recent survival experiences, was 10.3% 90% Female (97-00: Cohort analysis) Male (01-04: Period analysis) for males and 17.9% for females. The 80% Female (01-04: Period analysis) difference between males and females 70% was not statistically significant (p<0.05). (Fig. 5.4; App. 7) 60%
50% Neither estimate constituted a significant change from the actual five- 40% Relative survival (%) survival Relative year relative survival of those 30% diagnosed in 1997-2000, although it 20% should be emphasised that the results are not directly comparable. (Fig. 5.4; 10%
App. 7) 0% 00 01 02 03 04 05 Time since diagnosis (years)
24
Oesophageal cancer
5.5: International Comparisons EUROCARE-3 study The five-year age-standardised relative survival rate for males diagnosed with oesophageal cancer between 1993 and 1996 was 5.6% while for females the rate was 17.6%. Based upon the EUROCARE-3 study, for males this was similar to all other European countries with the exception of Spain which had significantly better survival. For females survival in Northern Ireland was better than in Denmark, Poland and Wales. (Fig. 5.5)
Figure 5.5: Comparison of five-year age-standardised relative survival from oesophageal cancer with other European countries (a) Male (b) Female
Northern Ireland Northern Ireland Austria Austria Czech Republic Czech Republic Denmark Denmark England England Estonia Estonia Finland Finland France France Germany Germany Iceland Iceland Italy Italy Malta Malta Netherlands Netherlands Norway Norway European country European country European Poland Poland Portugal Portugal Scotland Scotland Slovakia Slovakia Slovenia Slovenia Spain Spain Sweden Sweden Switzerland Switzerland Wales Wales EUROPE EUROPE
0% 5% 10% 15% 20% 25% 30% 35% 40% 0% 5% 10% 15% 20% 25% 30% 35% 40% Five-year relative survival (%) Five-year relative survival (%)
Source: EUROCARE-3 (2003) 27,28
Table 5.5: Five-year relative survival from oesophageal Other countries cancer for various countries The most recent estimates of five-year survival in Period of Country Male Female Northern Ireland were similar to those from other diagnosis countries including North America, Canada and New Northern Ireland 1997-2000 13.2% 12.3% Zealand. (Tab. 5.5) USA 1996-2002 15.4% 16.0% Canada 1995-1997 12.0% 15.0% Australia 1992-1997 - - 5.6: Summary and Discussion New Zealand 1994-1999 11.1% 13.6% Incidence and deaths from oesophageal cancer in Great Britain have been steadily rising over the last 30 years. This has not been the case in Northern Ireland over the last twelve years although this may be due to the shorter period of examination. Rates among males, however, are significantly higher than in females; a similar situation to the rest of the UK which is likely due to lifestyle factors35.
The major risk factors for oesophageal cancer are tobacco and alcohol use. Both of these can interact to give an even higher risk than either on their own with the risk increasing with increased tobacco and alcohol consumption36. A diet low in fresh fruit, vegetables and high protein foods resulting in insufficient quantities of zinc and vitamins being ingested also increases the risk of developing this cancer37. The consumption of
Northern Ireland Cancer Registry 25
Survival of cancer patients in Northern Ireland: 1993-2004 large quantities of fried, barbecued or roasted meat may increase risk38 while obesity significantly increases the chances of developing oesophageal cancer37.
Patients with gastro-oesophageal reflux, including those with Barrett’s oesophagus, are at a higher risk of developing adenocarcinoma of the oesophagus39,40 and human papillomavirus (HPV) is a possible, but as yet unproven, risk41. Certain drugs such as aminiphyllines and beta agonists can increase risk by a small amount while aspirin and anti-inflammatory drugs can have a slight protective effect38. Regular exposure over long periods of time to certain chemicals such as metal dust, vehicle exhaust, soot, lye or silica dust can increase the risk of developing this cancer38.
Survival from the disease is poor although improvement has occurred in male survival over the last decade so that male and female survival from the disease is similar. Age has an impact on one-year survival but not on longer term survival although this may be a result of the small number of cases examined. Surgical resection is seen to improve survival probability. Unfortunately not all patients qualify for these procedures due to poor health or advanced disease stage.
26
Stomach cancer
06: STOMACH CANCER (C16) KEY FACTS: • 148 male and 95 female cases per year between 2000 and 2004 with decreasing male (-2.5% p.a.) and female (-2.2% p.a.) incidence rates between 1993 and 2004; • 101 male and 71 female deaths per year between 2000 and 2004 with decreasing male (-3.6% p.a.) and no significant change in female mortality rates between 1993 and 2004; • Survival similar in males and females: 16.8% of males and 17.3% of females alive after five years, with no significant change in survival between 1993-1996 and 1997-2000; • Survival better for those aged 15-64 than for those aged 65 and over; • Survival similar to England, but worse than in Europe, USA, Canada and Australia.
6.1: Incidence and Mortality Incidence Stomach cancer was the fifth most common male cancer making up 3.3% of cases with an average of 148 males diagnosed each year during 2000-2004. Stomach cancer was less common among females being the ninth commonest cancer Table 6.1: Incidence and mortality: Stomach cancer (2000-2004) with an average of 95 females diagnosed annually (2.1% of Incidence Mortality Male Female Male Female female cancers). (Tab. 6.1) Number of cases/deaths per year 148 95 101 71 Percentage of all cancers 3.3% 2.1% 5.3% 4.0% Mortality Rank 5 9 4 6 Median age at diagnosis/death 71 75 72 77 Stomach cancer was the fourth Male to female ratio 1.6:1 - 1.4:1 - most common male cancer Incidence to mortality ratio 1.5:1 1.3:1 - - death during 2000-2004 with an Crude rate per 100,000 persons 17.9 10.9 12.2 8.2 annual average of 101 male European age-standardised rate 17.8 7.9 12.0 5.7 deaths, 5.3% of male cancer per 100,000 persons (95% CI) (16.5,19.1) (7.2,8.7) (10.9,13.1) (5.1,6.4) deaths. There were 71 stomach cancer deaths each year among females, making it sixth most common cause of female cancer death (4.0% of female cancer deaths). (Tab. 6.1)
Trends Male and female incidence rates (EASIR) for stomach cancer fell during 1993-2004 by 2.5% (p=0.015) and 2.2% per year (p=0.021) respectively. The fall in incidence rates corresponded to an annual decrease of 1.5 male and 1.0 female cases. (Fig. 6.1; App. 4&6)
Male mortality rates (EASMR) from stomach cancer decreased during 1993-2004 by 3.6% (p=0.002) each year; an average annual decrease of 2.0 deaths. No significant trend (p>0.05) existed for female EASMRs while the annual change in the number of deaths was close to zero. (Fig. 6.1; App. 5&6)
Figure 6.1: Incidence and mortality trends: Stomach cancer (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
30 30
25 25
20 20
15 15 persons persons
10 10
5 5
Male 100,000 rate per Agemortality standardised Male Age standardised incidence per 100,000 rate Female Female 0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
Northern Ireland Cancer Registry 27
Survival of cancer patients in Northern Ireland: 1993-2004
6.2: Relative Survival One-year relative survival from stomach cancer was 38.3% for patients diagnosed in 2001-2003 while five- year relative survival was 17.0% for patients diagnosed in 1997-2000. (Tab. 6.2)
Table 6.2: Relative survival from stomach cancer by sex and period of diagnosis (1993-2003) Survival time and RELATIVE SURVIVAL (95% CI) period of diagnosis Males Females All persons ALL PATIENTS 1993-1996 38.0% (34.0%, 42.0%) 32.4% (27.5%, 37.3%) 35.8% (32.7%, 39.0%) 1-year 1997-2000 35.9% (31.9%, 39.9%) 33.3% (28.3%, 38.3%) 34.9% (31.8%, 38.0%) 2001-2003 40.3% (35.7%, 45.0%) 34.8% (29.1%, 40.6%) 38.3% (34.6%, 41.9%)
1993-1996 19.3% (15.9%, 22.7%) 17.4% (13.3%, 21.6%) 18.6% (16.0%, 21.2%) 3-year 1997-2000 20.9% (17.3%, 24.5%) 18.7% (14.4%, 22.9%) 20.0% (17.3%, 22.8%)
1993-1996 15.2% (11.9%, 18.5%) 14.8% (10.8%, 18.8%) 15.0% (12.5%, 17.6%) 5-year 1997-2000 16.8% (13.3%, 20.3%) 17.3% (13.0%, 21.7%) 17.0% (14.3%, 19.7%)
7-year 1993-1996 13.7% (10.3%, 17.0%) 13.3% (9.3%, 17.2%) 13.5% (11.0%, 16.1%)
PATIENTS SURVIVING AT LEAST ONE YEAR (ONE-YEAR CONDITIONAL SURVIVAL) 1993-1996 50.5% (43.4%, 57.7%) 53.5% (43.7%, 63.2%) 51.5% (45.8%, 57.3%) 3-year* 1997-2000 57.9% (50.5%, 65.3%) 55.8% (46.1%, 65.4%) 57.1% (51.2%, 63.0%)
1993-1996 39.3% (31.9%, 46.8%) 45.0% (34.9%, 55.2%) 41.4% (35.4%, 47.4%) 5-year* 1997-2000 46.3% (38.3%, 54.3%) 51.5% (41.2%, 61.8%) 48.2% (41.9%, 54.6%)
7-year* 1993-1996 35.2% (27.4%, 42.9%) 40.3% (30.0%, 50.7%) 37.0% (30.8%, 43.2%) * from diagnosis
Sex Among stomach cancer patients diagnosed in 1997-2000 survival was similar for males and females with five-year relative survival 16.8% for males compared to 17.3% for females (p>0.05). (Tab. 6.2; Fig. 6.2)
Changes over time There were no statistically significant changes in relative survival for patients diagnosed with stomach cancer between 1993 and 2003, with 15.0% of those diagnosed in 1993-1996 alive after five years compared to 17.0% of those diagnosed in 1997-2000 (p>0.05). (Tab. 6.2; Fig. 6.2)
Figure 6.2: Relative survival from stomach cancer by Figure 6.3: Relative survival from stomach cancer by sex and period of diagnosis (1993-2000) period of diagnosis and whether or not patients survive at least one year (1993-2000)
100% 100% Male (93-96) All (93-96)
90% Female (93-96) 90% Survived one-year (93-96) Male (97-00) All (97-00) 80% Female (97-00) 80% Survived one-year (97-00)
70% 70%
60% 60%
50% 50%
40% 40% Relative survival (%) Relative survival (%) 30% 30%
20% 20%
10% 10%
0% 0% 00 01 02 03 04 05 00 01 02 03 04 05 Time since diagnosis (years) Time since diagnosis (years)
28
Stomach cancer
Conditional survival 34.9% of patients diagnosed with stomach cancer in 1997-2000 were alive one year from diagnosis. Of these patients 48.2% survived a further four years (i.e. five years in total). There were no differences in this conditional survival between males and females or over time during 1993-2003 (p>0.05). (Tab. 6.2; Fig. 6.3)
Age One-year relative survival was Table 6.3: Relative survival from stomach cancer by age and period of consistently better for those aged diagnosis (1993-2003) 15-64 during 1993-2003 (p=0.021). Survival time and RELATIVE SURVIVAL (95% CI) Additionally for patients diagnosed period of diagnosis Aged 15-64 Aged 65-99 in 1993-1996 five-year relative 1993-1996 45.7% (39.9%, 51.5%) 31.7% (28.1%, 35.3%) survival for those aged 15-64 was 1-year 1997-2000 46.1% (40.2%, 52.0%) 30.1% (26.4%, 33.7%) 47.8%, which was higher than the 2001-2003 47.8% (40.8%, 54.8%) 34.7% (30.5%, 38.9%)
34.7% of those aged 65-99 who 1993-1996 20.7% (15.9%, 25.6%) 12.5% (9.5%, 15.5%) survived five-years (p=0.039). 5-year 1997-2000 18.8% (14.0%, 23.6%) 16.6% (13.2%, 20.0%) (Tab. 6.3)
There were no changes in survival for either 15-64 or 65-99 year olds over time (p>0.05) nor were there any statistically significant changes in survival over time for individual male or female age groups during 1993-2003. (Tab. 6.3; Fig. 6.4; App. 8)
Figure 6.4: Relative survival from stomach cancer by age, sex and period of diagnosis (1993-2003) (a) One-year (b) Five-year
100% 1993-1996 1997-2000 2001-2003 100% 1993-1996 1997-2000
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40% Relative survival (%) 30% Relative survival (%) 30%
20% 20%
10% 10%
0% 0% Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female 15-44 45-54 55-64 65-74 75+ 15-44 45-54 55-64 65-74 75+ Sex and Age Sex and Age Note: Missing entries refer to less than 10 persons in that age/sex group
6.3: Observed Survival Observed survival from stomach cancer, which takes into account deaths from all causes, was very poor with 38.9% of male and 33.5% of female patients diagnosed in 2001-2003 alive after one-year. Five-year observed survival was 13.6% for male and 14.6% for female patients diagnosed in 1997-2000. (Tab. 6.4)
Table 6.4: Observed survival from stomach cancer by sex and period of diagnosis (1993-2003) Survival time and OBSERVED SURVIVAL (95% CI) period of diagnosis Males Females All persons 1993-1996 36.4% (32.5%, 40.2%) 31.2% (26.5%, 35.9%) 34.4% (31.4%, 37.4%) 1-year 1997-2000 34.5% (30.6%, 38.3%) 32.0% (27.2%, 36.9%) 33.5% (30.5%, 36.6%) 2001-2003 38.9% (34.4%, 43.4%) 33.5% (27.9%, 39.0%) 36.8% (33.3%, 40.3%)
1993-1996 12.0% (9.4%, 14.6%) 12.4% (9.0%, 15.7%) 12.1% (10.1%, 14.2%) 5-year 1997-2000 13.6% (10.8%, 16.4%) 14.6% (10.9%, 18.2%) 13.9% (11.7%, 16.2%)
Northern Ireland Cancer Registry 29
Survival of cancer patients in Northern Ireland: 1993-2004
6.4: Period Analysis Figure 6.5: Estimated relative survival (period analysis) from stomach cancer for patients diagnosed in 2001-2004 compared with actual Five-year survival from stomach relative survival (cohort analysis) for patients diagnosed in 1997-2000. cancer for patients diagnosed in 2001- 100% 2004 cannot be derived using Male (97-00: Cohort analysis) 90% Female (97-00: Cohort analysis) traditional methods (cohort analysis) Male (01-04: Period analysis) but can be estimated using newer 80% Female (01-04: Period analysis) techniques (period analysis). Using 70% this method five-year survival from stomach cancer for males diagnosed 60% in 2001-2004 was 19.2% while for 50% females it was 16.9%. This does not 40% represent a significant difference Relative survival (%) survival Relative between the two sexes (p>0.05). (Fig. 30%
6.5; App. 7) 20%
While not directly comparable the 10% results from the period analysis do not 0% 00 01 02 03 04 05 constitute a significant difference from Time since diagnosis (years) the actual five-year relative survival derived using cohort analysis for patients diagnosed in 1997-2000 (p>0.05). (Fig. 6.5; App. 7)
6.5: International Comparisons EUROCARE-3 study The five-year age-standardised relative survival rate for males diagnosed with stomach cancer in 1993- 1996 was 15.3%, which was significantly lower than the 20.0% in Europe. For females the five-year age- standardised relative survival rate was 15.5%, which was also significantly lower than the 25.4% in Europe.
Figure 6.6: Comparison of five-year age-standardised relative survival from stomach cancer with other European countries (a) Male (b) Female
Northern Ireland Northern Ireland Austria Austria Czech Republic Czech Republic Denmark Denmark England England Estonia Estonia Finland Finland France France Germany Germany Iceland Iceland Italy Italy Malta Malta Netherlands Netherlands Norway Norway European country European country European Poland Poland Portugal Portugal Scotland Scotland Slovakia Slovakia Slovenia Slovenia Spain Spain Sweden Sweden Switzerland Switzerland Wales Wales EUROPE EUROPE
0% 10% 20% 30% 40% 50% 0% 10% 20% 30% 40% 50% Five-year relative survival (%) Five-year relative survival (%)
Source: EUROCARE-3 (2003) 27,28
30
Stomach cancer
A comparison with individual European countries illustrated that survival for males and females from this cancer was significantly lower than many other European countries but was similar to that in England. Male survival from this disease was however better than that found in Scotland and Wales. (Fig. 6.6)
Other countries Table 6.5: Five-year relative survival from stomach cancer for various countries More recent studies illustrate survival from this Period of Country Male Female cancer in Northern Ireland was lower than in USA, diagnosis Canada and Australia, particularly for females. Northern Ireland 1997-2000 16.8% 17.3% (Tab. 6.5) USA 1996-2002 22.7% 25.6% Canada 1995-1997 20.0% 27.0% Australia 1992-1997 22.6% 24.8% 6.6: Summary and Discussion New Zealand 1994-1999 19.6% 19.6% There is epidemiological evidence of associations between stomach cancer and diets with salty and smoked foods42 while a diet high in fresh fruit and vegetables is seen to reduce the risk of stomach cancer due to the protective effect of vitamin C on the stomach lining43. The consumption of preserved foods which contain N-nitroso compounds, nitrates and nitrites as preservatives may increase the risk of stomach cancer, however further studies are required to confirm this conclusion42.
Other risk factors that have been shown to be important for this cancer include tobacco use44 and infection with helicobacter pylori bacteria45,46. People with pernicious anaemia have a risk of developing stomach cancer which is 2 to 3 times that of the general population47 and having atrophic gastritis can also increase risk42. The inherited condition, familial adenomatous polyposis (FAP) is associated with an elevated risk42 as is exposure to ionising radiation42.
Stomach cancer is decreasing in Northern Ireland for both males and females however survival from the disease is poor with no improvements in prognosis over time. Survival from the disease depends upon age while patients selected for surgery have better survival possibilities.
Northern Ireland Cancer Registry 31
Survival of cancer patients in Northern Ireland: 1993-2004
07: COLORECTAL CANCER (Colon, rectosigmoid junction & anus) (C18-C21) KEY FACTS: • 504 male and 439 female cases diagnosed each year during 2000-2004 with an annual decrease of 1.3% in female and no significant change in male incidence rates during 1993-2004; • 221 male and 197 female deaths from the disease each year between 2000 and 2004 with an annual decrease of 2.5% in female and no significant change in male mortality rates during 1993-2004; • Incidence higher in Derry, Larne and Newry & Mourne and in the 20% most deprived areas of Northern Ireland; Mortality also higher in Larne and in the 20% most deprived areas; • Five-year survival for patients diagnosed in 1997-2000 was 52.5% with five-year survival having improved by 6.3% for patients diagnosed in 1997-2000 compared to those diagnosed in 1993-1996; • Survival was better for 15-64 year olds than for 65-99 year olds and for patients diagnosed with colorectal cancer at an early stage; • Five-year survival for patients diagnosed at Dukes Stage C increased by 13.1% between 1993-1996 and 1997-2000; • Five-year survival was not related to deprivation or urban/rural factors; • Survival was similar to Europe, the rest of the UK and Ireland but lower than in USA and Canada.
7.1: Incidence and Mortality Incidence Colorectal cancer accounted for 11.1% of male and 9.7% of female cancers diagnosed between 2000 and 2004 with an average of 504 male and 439 female cases per year. It was the fourth most common male cancer and third most common Table 7.1: Incidence and mortality: Colorectal cancer (2000-2004) among females. Age- standardised rates of this cancer Incidence Mortality Male Female Male Female were 51% higher among males Number of cases/deaths per year 504 439 221 197 than females. (Tab. 7.1) Percentage of all cancers 11.1% 9.7% 11.7% 11.0% Rank 4 3 2 3 Mortality Median age at diagnosis/death 70 72 72 76 Male to female ratio 1.1:1 - 1.1:1 - During 2000-2004, there were Incidence to mortality ratio 2.3:1 2.2:1 - - on average, 221 male and 197 Crude rate per 100,000 persons 60.8 50.6 26.7 22.7 female deaths per year European age-standardised rate 61.5 40.3 26.9 16.5 representing 11.7% and 11.0% per 100,000 persons (95% CI) (59.0,63.9) (38.5,42.0) (25.3,28.5) (15.4,17.6) of all male and female cancer deaths respectively. It was the second most common male cancer death and the third most common female cancer death. (Tab. 7.1)
Trends During 1993-2004 male cases of colorectal cancer rose by an average of 3.4 per year, however there was no significant trend in incidence rates (EASIR) (p>0.05). Female cases decreased by an average of 1.7
Figure 7.1: Incidence and mortality trends: Colorectal cancer (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
80 80
70 70
60 60
50 50
40 40 persons persons 30 30
20 20
10 10 Age standardised mortality rate per 100,000 rate Agestandardised mortality
Age standardised incidence rate per 100,000 Age standardised incidence rate Male Male Female Female 0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
32
Colorectal cancer each year, reflecting an annual decrease of 1.3% in EASIRs (p=0.003). (Fig. 7.1; App. 4&6)
Among males, mortality rates (EASMR) were static (p>0.05) between 1993 and 2004, as were the actual number of deaths. Female EASMRs however decreased by 2.5% per year (p=0.005), which was equivalent to a fall of 3.3 deaths per year. (Fig. 7.1; App. 5&6)
Geographic variation Incidence and mortality from colorectal cancer was higher in the 20% most deprived areas of Northern Ireland than in Northern Ireland as a whole during 1993-2004. However, there was no conclusive relationship between urban/rural factors and incidence and mortality from this disease. (Fig. 7.2)
Figure 7.2: Standardised incidence and mortality ratios for colorectal cancer by settlement band and deprivation quintile: 1993-2004 (a) Settlement band (b) Deprivation quintile
Small village, hamlet, open countryside Least Deprived
Village
Intermediate Quintile 4 settlement
Small town Quintile 3
Medium town Settlement Band
Large town Deprivation Quintile Quintile 2
Derry Urban Area
Most Deprived Incidence Belfast Metropolitan Incidence Mortality Urban Area Mortality
50 60 70 80 90 100 110 120 130 140 150 50 60 70 80 90 100 110 120 130 140 150 Lower Standardised Ratio Higher Lower Standardised Ratio Higher
During 1993-2004 incidence of colorectal cancer was higher in Derry, Larne and Newry & Mourne District Councils than Northern Ireland, with mortality higher in Larne. Lower incidence rates were found in Ards, Carrickfergus and Castlereagh with lower than expected mortality rates in Ards and Craigavon. (Tab. 7.2)
Table 7.2: Standardised incidence and mortality ratios for colorectal cancer by District Council: 1993-2004 Local Standardised Standardised Local Standardised Standardised Government Incidence Ratio Mortality Ratio Government Incidence Ratio Mortality Ratio District (95% CI) (95% CI) District (95% CI) (95% CI) Antrim 99.4 (87.6, 111.2) 104.0 (85.9, 122.1) Down 106.7 (96.7, 116.7) 97.6 (83.5, 111.7) Ards 87.5 (79.5, 95.6) 87.0 (75.1, 98.9) Dungannon 98.2 (86.9, 109.5) 103.1 (85.8, 120.4) Armagh 93.9 (83.6, 104.2) 105.2 (89.0, 121.4) Fermanagh 99.7 (89.8, 109.5) 96.9 (82.6, 111.1) Ballymena 96.2 (86.8, 105.6) 111.0 (96.1, 125.9) Larne 114.0 (100.1, 127.9) 123.1 (101.7, 144.5) Ballymoney 107.2 (92.0, 122.4) 107.0 (84.4, 129.6) Limavady 93.1 (78.5, 107.8) 108.1 (84.4, 131.8) Banbridge 90.5 (79.0, 102.1) 92.8 (75.4, 110.2) Lisburn 98.2 (90.6, 105.8) 95.7 (84.5, 106.9) Belfast 100.8 (96.5, 105.1) 102.8 (96.4, 109.1) Magherafelt 103.0 (89.9, 116.2) 103.8 (84.2, 123.5) Carrickfergus 88.2 (76.4, 99.9) 87.9 (70.4, 105.3) Moyle 97.7 (79.7, 115.7) 103.4 (76.1, 130.7) Castlereagh 87.9 (79.9, 96.0) 94.3 (82.0, 106.7) Newry & Mourne 117.4 (107.9, 126.8) 111.7 (98.0, 125.5) Coleraine 101.1 (91.2, 111.0) 102.2 (87.4, 116.9) Newtownabbey 107.1 (98.4, 115.8) 100.5 (88.0, 113.0) Cookstown 89.2 (76.0, 102.5) 82.0 (63.2, 100.8) North Down 98.8 (91.0, 106.7) 91.2 (80.2, 102.2) Craigavon 95.5 (87.0, 104.0) 87.4 (75.3, 99.6) Omagh 103.2 (91.3, 115.0) 95.1 (78.3, 112.0) Derry 111.4 (102.4, 120.4) 110.1 (96.6, 123.6) Strabane 103.3 (90.0, 116.6) 104.0 (84.0, 124.0) SIRs/SMRs in blue represent significantly lower or higher incidence or mortality than in Northern Ireland as a whole.
Northern Ireland Cancer Registry 33
Survival of cancer patients in Northern Ireland: 1993-2004
7.2: Relative Survival One-year relative survival from colorectal cancer was 74.7% for patients diagnosed in 2001-2003 while five- year relative survival was 52.5% for patients diagnosed in 1997-2000. (Tab. 7.3)
Table 7.3: Relative survival from colorectal cancer by sex and period of diagnosis (1993-2003) Survival time and RELATIVE SURVIVAL (95% CI) period of diagnosis Males Females All persons ALL PATIENTS 1993-1996 71.1% (68.9%, 73.3%) 69.6% (67.3%, 71.9%) 70.4% (68.8%, 72.0%) 1-year 1997-2000 73.9% (71.7%, 76.2%) 73.7% (71.4%, 75.9%) 73.8% (72.2%, 75.4%) 2001-2003 75.4% (72.9%, 77.8%) 73.9% (71.2%, 76.5%) 74.7% (72.9%, 76.5%)
1993-1996 53.1% (50.5%, 55.8%) 52.2% (49.6%, 54.9%) 52.7% (50.8%, 54.6%) 3-year 1997-2000 57.3% (54.6%, 60.0%) 58.3% (55.6%, 60.9%) 57.8% (55.9%, 59.7%)
1993-1996 46.7% (43.9%, 49.5%) 45.7% (42.9%, 48.5%) 46.2% (44.2%, 48.2%) 5-year 1997-2000 51.9% (48.9%, 54.8%) 53.1% (50.2%, 56.0%) 52.5% (50.4%, 54.6%)
7-year 1993-1996 44.1% (41.1%, 47.1%) 43.6% (40.6%, 46.6%) 43.9% (41.8%, 46.0%)
PATIENTS SURVIVING AT LEAST ONE YEAR (ONE-YEAR CONDITIONAL SURVIVAL) 1993-1996 74.1% (71.3%, 77.0%) 74.3% (71.4%, 77.1%) 74.2% (72.2%, 76.2%) 3-year* 1997-2000 77.0% (74.2%, 79.8%) 78.6% (75.9%, 81.2%) 77.8% (75.9%, 79.7%)
1993-1996 64.5% (61.2%, 67.9%) 64.4% (61.1%, 67.8%) 64.5% (62.1%, 66.9%) 5-year* 1997-2000 69.2% (65.9%, 72.6%) 71.2% (68.0%, 74.4%) 70.2% (67.9%, 72.5%)
7-year* 1993-1996 60.6% (56.9%, 62.4%) 61.1% (57.4%, 63.0%) 60.8% (58.2%, 63.4%) * from diagnosis
Sex Relative survival from colorectal cancer was similar for males and females. For example, 51.9% of males diagnosed in 1997-2000 were alive after five years compared to 53.1% of females. (Tab. 7.3; Fig. 7.3)
Changes over time There was a significant improvement in one-year relative survival for patients diagnosed with colorectal cancer during 1993-2003 with 74.7% of all patients diagnosed between 2001 and 2003 surviving one year compared to 70.4% of all patients diagnosed between 1993 and 1996 (p=0.014).
Figure 7.3: Relative survival from colorectal cancer by Figure 7.4: Relative survival from colorectal cancer by sex and period of diagnosis (1993-2000) period of diagnosis and whether or not patients survive at least one year (1993-2000) 100% 100%
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40% Relative survival(%) Relative survival (%) 30% 30%
20% Male (93-96) 20% All (93-96) Female (93-96) Survived one-year (93-96) 10% Male (97-00) 10% All (97-00) Female (97-00) Survived one-year (97-00) 0% 0% 00 01 02 03 04 05 00 01 02 03 04 05 Time since diagnosis (years) Time since diagnosis (years)
34
Colorectal cancer
Five-year relative survival also improved, with an additional 6.3% of patients surviving five years from a diagnosis during 1997-2000 compared with those diagnosed in 1993-1996 (p=0.003). In particular five-year relative survival increased for female patients from 45.7% to 53.1% (p=0.012) with changes in male survival not statistically significant. (Tab. 7.3; Fig. 7.3)
Conditional survival For patients diagnosed with colorectal cancer during 1997-2000 who survived at least one year after diagnosis 70.2% were alive five years from original diagnosis, while seven-year relative survival for patients diagnosed between 1993 and 1996 who survived at least one-year after diagnosis was 60.8%. This conditional survival was similar for both males and females (p>0.05). (Tab. 7.3)
Relative survival for a further four years for patients who had already survived one year improved during 1993-2000 from 64.5% for those diagnosed in 1993-1996 to 70.2% for those diagnosed in 1997-2000 (p=0.017). This improvement in conditional survival was significant for females (p=0.044) but not for males (p>0.05). (Tab. 7.3; Fig. 7.4)
Age Relative survival from colorectal Table 7.4: Relative survival from colorectal cancer by age and period of cancer for those aged 15-64 was diagnosis (1993-2003) better than for those aged 65-99, Survival time and RELATIVE SURVIVAL (95% CI) with a 11.5% difference in five-year period of diagnosis Aged 15-64 Aged 65-99 survival for those diagnosed in 1993-1996 77.5% (74.9%, 80.0%) 67.3% (65.3%, 69.3%) 1997-2000 (p<0.001). (Tab. 7.4) 1-year 1997-2000 85.4% (83.2%, 87.6%) 68.4% (66.3%, 70.5%) 2001-2003 81.9% (79.3%, 84.6%) 71.1% (68.8%, 73.4%)
Five-year relative survival for those 1993-1996 50.1% (47.0%, 53.2%) 44.5% (42.0%, 47.1%) aged 15-64 improved during 1993- 5-year 1997-2000 60.3% (57.2%, 63.5%) 48.8% (46.1%, 51.5%) 2003 with a 10.2% increase for those diagnosed in 1997-2000 compared to 1993-1996 (p=0.001). In particular, for those aged 55-64 survival improved between 1993-1996 and 1997-2000 by 15.8% for females (p=0.008) and 11.6% for males (p=0.040). (Tab. 7.4; Fig. 7.5)
Figure 7.5: Relative survival from colorectal cancer by age, sex and period of diagnosis (1993-2003) (a) One-year (b) Five-year
100% 1993-1996 1997-2000 2001-2003 100% 1993-1996 1997-2000
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40% Relative survival (%) survival Relative
30% Relative survival (%) 30%
20% 20%
10% 10%
0% 0% Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female 15-44 45-54 55-64 65-74 75+ 15-44 45-54 55-64 65-74 75+ Sex and Age Sex and Age Deprivation and urban/rural factors For patients diagnosed with colorectal cancer in 1993-2000 one-year relative survival was significantly higher in the 20% least deprived areas of Northern Ireland than in the 20% most deprived (p=0.014) and the 20-40% (quintile 2) most deprived areas (p=0.002). Five-year relative survival for patients resident in the most deprived areas was also slightly lower than for those in the most affluent areas, however these differences were not statistically significant (p>0.05). (Fig. 7.6)
The type of settlement that a patient resided in was not a significant factor in patient survival. (Fig. 7.6)
Northern Ireland Cancer Registry 35
Survival of cancer patients in Northern Ireland: 1993-2004
Figure 7.6: Relative survival from colorectal cancer by deprivation quintile and settlement band (1993-2000) (a) Deprivation quintile (b) Settlement band
1-year Belfast Metropolitan 1-year Area Most deprived 5-year 5-year
Derry Urban Area
Quintile 2 Large town
Medium town
Quintile 3 Small town Settlement band Settlement Deprivation quintile Intermediate settlement Quintile 4
Village
Least deprived Small village, hamlet and open countryside
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Relative survival (%) Relative survival (%)
Stage Relative survival from colorectal cancer Figure 7.7: Relative survival from colorectal cancer by stage (1997- decreased with increasing stage during 2000) 1993-2003 (see App. 3 for definitions). 100% Five-year relative survival for patients 90% Dukes A diagnosed with colorectal cancer at 80% Dukes Stage A in 1997-2000 was Dukes B 91.9% while for those diagnosed at 70%
Dukes Stage D five-year relative 60% survival was 11.2%. Slightly over 31% Dukes C of patients did not have a stage 50% assigned. Survival for these patients 40% Unstaged was poor with 37.6% surviving five Relative survival (%) 30% years. (Tab. 7.5) 20%
Improvements in survival during 1993- 10% Dukes D 2003 existed for patients diagnosed 0% with colorectal cancer at Dukes Stage 00 01 02 03 04 05 C with five-year relative survival Time since diagnosis (years) increasing from 34.6% for patients diagnosed in 1993-1996 to 47.7% for patients diagnosed in 1997-2000 (p<0.001). (Tab. 7.5; Fig. 7.7)
Table 7.5: Relative survival from colorectal cancer by stage and period of diagnosis (1993-2003) Period of RELATIVE SURVIVAL (95% CI) diagnosis Dukes A Dukes B Dukes C Dukes D Unstaged 1-year 1993-96 97.8% (94.5%, 101.2%) 92.2% (90.1%, 94.4%) 76.5% (73.4%, 79.6%) 48.8% (42.0%, 55.6%) 51.8% (49.1%, 54.6%) 1997-00 96.5% (93.1%, 99.8%) 91.0% (88.6%, 93.3%) 79.4% (76.4%, 82.4%) 45.7% (38.3%, 53.1%) 59.2% (56.4%, 62.0%) 2001-03 98.3% (95.0%, 101.6%) 94.0% (91.6%, 96.4%) 83.4% (80.4%, 86.4%) 45.4% (39.9%, 51.0%) 57.4% (53.7%, 61.1%) 5-year 1993-96 93.5% (86.1%, 100.8%) 73.3% (69.2%, 77.4%) 34.6% (30.8%, 38.4%) 15.3% (9.9%, 20.7%) 33.3% (30.3%, 36.2%) 1997-00 91.9% (85.2%, 98.6%) 78.9% (74.7%, 83.1%) 47.7% (43.7%, 51.7%) 11.2% (6.1%, 16.3%) 37.6% (34.5%, 40.8%)
7.3: Observed Survival One-year observed survival (which takes into account deaths from all causes and therefore is lower than relative survival) from colorectal cancer was 72.4% for male and 71.3% for female patients diagnosed between 2001 and 2003. Five-year observed survival was 41.4% for male and 43.9% for female patients diagnosed between 1997 and 2000. (Tab. 7.6)
36
Colorectal cancer
As with relative survival there were improvements in five-year observed survival for females diagnosed in 1997-2000 compared to 1993-1996 with a rise from 36.9% to 43.9% (p=0.003). Changes in male five-year observed survival were also statistically significant with a rise from 36.2% to 41.4% between the two time periods (p=0.024). (Tab. 7.6)
Table 7.6: Observed survival from colorectal cancer by sex and period of diagnosis (1993-2003) Survival time and OBSERVED SURVIVAL (95% CI) period of diagnosis Males Females All persons 1993-1996 67.8% (65.7%, 69.9%) 67.0% (64.7%, 69.2%) 67.4% (65.8%, 68.9%) 1-year 1997-2000 70.8% (68.6%, 72.9%) 71.1% (68.9%, 73.2%) 70.9% (69.4%, 72.4%) 2001-2003 72.4% (70.0%, 74.7%) 71.3% (68.7%, 73.8%) 71.9% (70.1%, 73.6%)
1993-1996 36.2% (34.0%, 38.4%) 36.9% (34.6%, 39.2%) 36.5% (34.9%, 38.1%) 5-year 1997-2000 41.4% (39.0%, 43.7%) 43.9% (41.5%, 46.3%) 42.6% (41.0%, 44.3%)
7.4: Period Analysis Traditional methods for producing five- Figure 7.8: Estimated relative survival (period analysis) from colorectal year relative survival rates (cohort cancer for patients diagnosed in 2001-2004 compared with actual relative survival (cohort analysis) for patients diagnosed in 1997-2000. analysis) require five-years worth of follow up data and thus do not reflect 100% more recent survival experience. More 90% up to date survival rates can be 80% estimated using newer techniques such as period analysis. 70%
60% Five-year survival from colorectal 50% cancer for males diagnosed in 2001- 2004 derived using this approach was 40% Relative survival(%) 52.2% while for females it was 54.5%. 30% While not directly comparable with 20% Male (97-00: Cohort analysis) results from traditional methods these Female (97-00: Cohort analysis) estimates do not represent an 10% Male (01-04: Period analysis) Female (01-04: Period analysis) improvement in survival for male or 0% female patients compared to those 00 01 02 03 04 05 Time since diagnosis (years) diagnosed in 1997-2000. Comparisons with 1993-1996 however show improvements in female survival, while increases in male survival did not reach statistical significance only by a slight margin. (Fig. 7.8; App. 7)
7.5: International Comparisons EUROCARE-4 study Age-standardised five-year relative survival from colorectal cancer in Northern Ireland during the late 1990s was similar to that in England, Scotland, Ireland, Wales and Europe as a whole. Northern Ireland however had better survival than in the Czech Republic, Poland and Slovenia, with worse survival than in Belgium, Finland, France, Italy, Netherlands, Norway, Sweden and Switzerland for both sexes and for females in Germany and Austria. (Fig. 7.9)
Table 7.7: Five-year relative survival from colorectal Other countries cancer for various countries Period of Five-year relative survival in Northern Ireland was Country Male Female diagnosis significantly lower for patients diagnosed in the late Northern Ireland 1997-2000 51.9% 53.1% 1990s than for patients resident in USA, Canada and USA 1996-2002 65.0% 63.2% New Zealand. (Tab. 7.7) Canada 1995-1997 59.0% 60.5% Australia 1992-1997 - - New Zealand 1994-1999 58.8% 61.5%
Northern Ireland Cancer Registry 37
Survival of cancer patients in Northern Ireland: 1993-2004
Figure 7.9:Comparison of five-year age-standardised relative survival from colorectal cancer with other European countries (a) Male (b) Female
Northern Ireland Northern Ireland Austria Austria Belgium Belgium Czech Czech Denmark Denmark Finland Finland France France Germany Germany Iceland Iceland Ireland Ireland Italy Italy Malta Malta Netherlands Netherlands Norway Norway European country European country European Poland Poland Portugal Portugal Slovenia Slovenia Spain Spain Sweden Sweden Switzerland Switzerland UK_England UK_England UK_Scotland UK_Scotland UK_Wales UK_Wales Europe Europe
0% 10% 20% 30% 40% 50% 60% 70% 0% 10% 20% 30% 40% 50% 60% 70% Five-year relative survival (%) Five-year relative survival (%)
Source:EUROCARE-4 (2007)29 7.6: Summary and Discussion Colorectal cancer is one of the most common cancers in Northern Ireland. Symptoms of the disease include bleeding from the rectum or blood in stools, permanent changes in normal bowel habits, a lump in the right side of the abdomen or rectum, losing weight, abdominal pain or anaemia (low red blood cells)48.
Evidence exists that diets with less red and processed meat, less carbohydrates and more vegetables and fibre are associated with a reduced risk of bowel cancer49,50. Physical exercise has been shown in epidemiological studies to reduce the risk of colon cancer by 40-50%51,52. Other high risk groups are those with a strong family history such as having two or more close relatives or one relative aged less than 45 years having been diagnosed with colorectal cancer53. Two further inherited conditions; familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer (HNPCC) also increase the risk of colorectal cancer. FAP accounts for 1% of colorectal cancers and HNPCC accounts for 5% of colorectal cancers53. Colon cancers are also more common in people with chronic inflammatory disease of their bowels such as ulcerative colitis and Crohn’s disease and among those with diabetes53. Hormone replacement therapy (HRT), the contraceptive pill and vitamin D may help protect against this disease53. Some studies have shown that non-steroidal anti-inflammatory drugs reduce the risk of both colon and rectal cancer54.
Rates of new cases and deaths from this disease have fallen over the last twelve years in Northern Ireland while male rates have remained steady. Survival from the disease is moderate at 53% and is steadily improving with further improvement possible as a result of advances in endoscopic technology that allows diagnosis of the disease at an earlier stage. The introduction of colorectal screening in Northern Ireland in 2009 is expected to increase the percentage of colorectal cancers diagnosed at an early stage, thus further improving survival.
Age and stage at diagnosis are major factors in survival from colorectal cancer with the difference in survival between those diagnosed at an early and late stage being very extreme. No link between survival
38
Colorectal cancer and urban/rural factors exists but a slight variation in short term survival exists between the most deprived and most affluent areas in Northern Ireland. Differences also exist in survival when compared with other countries including USA; however the rest of the UK exhibits similar survival rates.
Northern Ireland Cancer Registry 39
Survival of cancer patients in Northern Ireland: 1993-2004
08: CANCER OF THE COLON (C18) KEY FACTS: • 301 male and 293 female cases per year during 2000-2004 with decreasing male (-1.6% p.a.) and female (-1.9% p.a.) incidence rates between 1993 and 2004; • 150 male and 138 female deaths per year in 2000-2004 with decreasing male (-2.4% p.a.) and female (-4.0% p.a.) mortality rates between 1993 and 2004; • Survival similar in males and females: 53.5% of males and 53.9% of females alive after five years with five-year relative survival having improved by 6.8% for all patients between 1993-1996 and 1997-2000; • Survival better for those aged 15-64 than for those aged 65 and over, with five-year relative survival for 15-64 year olds having improved between 1993-1996 and 1997-2000 by 12.8%; • Estimates using period analysis suggest that five-year survival will improve further for females diagnosed in 2001- 2004; • Survival similar to England and Scotland, but worse than in USA, Australia, France and Spain.
8.1: Incidence and Mortality Incidence Between 2000 and 2004 there were an average of 301 male and 293 female cases of cancer of the colon diagnosed each year, which represented 6.6% of male and 6.4% of female cancers. (Tab. 8.1)
Table 8.1: Incidence and mortality: Cancer of the colon (2000-2004) Mortality Incidence Mortality During the same five-year period Male Female Male Female there were 150 male and 138 Number of cases/deaths per year 301 293 150 138 female deaths annually as a Percentage of all cancers 6.6% 6.4% 8.0% 7.7% result of this cancer. This Median age at diagnosis/death 71 73 72 77 Male to female ratio 1.0:1 - 1.1:1 - represented 8.0% of male and Incidence to mortality ratio 2.0:1 2.1:1 - - 7.7% of female cancer deaths. Crude rate per 100,000 persons 36.3 33.8 18.1 15.9 (Tab. 8.1) European age-standardised rate 36.4 26.5 18.3 11.3 per 100,000 persons (95% CI) (34.6,38.3) (25.0,27.9) (17.0,19.7) (10.4,12.2) Trends Incidence rates (EASIR) for cancer of the colon decreased during 1993-2004 for both sexes by 1.6% (p=0.001) for males and 1.9% (p=0.010) for females. Despite the decline in rates the actual number of newly diagnosed male cases remained constant during the period, although the number of female cases decreased by 2.8 cases each year. (Fig. 8.1; App. 4&6)
Mortality rates (EASMR) for cancer of the colon also fell during this period by 2.4% (p=0.017) for males and 4.0% (p<0.001) for females. The decrease in rates represented a fall of 1.5 male and 4.2 female deaths each year. (Fig. 8.1; App. 5&6)
Figure 8.1: Incidence and mortality trends: Cancer of the colon (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
50 50
45 45
40 40
35 35
30 30
25 25 persons persons 20 20
15 15
10 10
5 per 100,000 rate standardised mortality Age 5 Age standardised incidence rate per 100,000 Age standardised incidence rate Male Male Female Female 0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
40
Cancer of the colon
8.2: Relative Survival Relative survival from cancer of the colon was average with 73.2% of patients diagnosed between 2001 and 2003 surviving one-year and 53.7% of patients diagnosed between 1997 and 2000 surviving five years. (Tab. 8.2)
Table 8.2: Relative survival from cancer of the colon by sex and period of diagnosis (1993-2003) Survival time and RELATIVE SURVIVAL (95% CI) period of diagnosis Males Females All persons ALL PATIENTS 1993-1996 70.1% (67.2%, 72.9%) 67.9% (65.1%, 70.7%) 69.0% (67.0%, 71.0%) 1-year 1997-2000 72.5% (69.6%, 75.3%) 70.9% (68.1%, 73.6%) 71.6% (69.6%, 73.6%) 2001-2003 73.3% (70.0%, 76.5%) 73.2% (70.0%, 76.5%) 73.2% (70.9%, 75.5%)
1993-1996 52.9% (49.5%, 56.2%) 53.0% (49.8%, 56.2%) 52.9% (50.6%, 55.3%) 3-year 1997-2000 57.4% (53.9%, 60.8%) 57.7% (54.5%, 60.9%) 57.5% (55.2%, 59.9%)
1993-1996 46.8% (43.2%, 50.4%) 47.0% (43.6%, 50.4%) 46.9% (44.4%, 49.4%) 5-year 1997-2000 53.5% (49.7%, 57.2%) 53.9% (50.4%, 57.4%) 53.7% (51.1%, 56.3%)
7-year 1993-1996 45.7% (41.7%, 49.6%) 45.1% (41.4%, 48.7%) 45.4% (42.7%, 48.1%)
PATIENTS SURVIVING AT LEAST ONE YEAR (ONE-YEAR CONDITIONAL SURVIVAL) 1993-1996 74.9% (71.3%, 78.5%) 77.2% (73.8%, 80.6%) 76.1% (73.6%, 78.6%) 3-year* 1997-2000 78.7% (75.2%, 82.2%) 80.9% (77.7%, 84.1%) 79.8% (77.5%, 82.2%)
1993-1996 65.6% (61.3%, 69.9%) 67.8% (63.8%, 71.9%) 66.8% (63.8%, 69.7%) 5-year* 1997-2000 72.9% (68.6%, 77.1%) 75.1% (71.3%, 79.0%) 74.0% (71.2%, 76.9%)
7-year* 1993-1996 63.6% (58.8%, 68.4%) 64.5% (60.0%, 69.3%) 64.1% (60.8%, 67.4%) * from diagnosis Sex There were no statistically significant differences in one or five-year relative survival for males and females (p>0.05) diagnosed with cancer of the colon between 1993 and 2003. (Tab. 8.2; Fig. 8.2)
Changes over time Five-year relative survival improved for all persons between 1993-1996 and 1997-2000 with an additional 6.8% of patients surviving five years from diagnosis (p=0.009). Differences over time for male and female patients considered separately were not statistically significant (p>0.05). (Tab. 8.2; Fig. 8.2)
Figure 8.2: Relative survival from cancer of the colon by Figure 8.3: Relative survival from cancer of the colon by sex and period of diagnosis (1993-2000) period of diagnosis and whether or not patients survive at least one year (1993-2000) 100% 100%
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40%
Relative survival (%) 30% Relative survival (%) 30%
20% Male (93-96) 20% All (93-96) Female (93-96) Survived one-year (93-96) 10% Male (97-00) 10% All (97-00) Female (97-00) Survived one-year (97-00) 0% 0% 00 01 02 03 04 05 00 01 02 03 04 05 Time since diagnosis (years) Time since diagnosis (years)
Northern Ireland Cancer Registry 41
Survival of cancer patients in Northern Ireland: 1993-2004
Conditional survival Five-year relative survival for patients who survived one year from diagnosis and were diagnosed in 1997- 2000 was 74.0%, an improvement on the 66.8% of those diagnosed in 1993-1996 (p=0.014). Seven-year survival for those diagnosed in 1993-1996 was 64.1%, with neither of these conditional survival rates varying by sex. (Tab. 8.2; Fig. 8.3)
Age Table 8.3: Relative survival from cancer of the colon by age and period of Survival among those aged under diagnosis (1993-2003) 65 was better than those aged 65 Survival time and RELATIVE SURVIVAL (95% CI) and over with 62.8% of patients period of diagnosis Aged 15-64 Aged 65-99 aged under 65 and diagnosed in 1993-1996 75.2% (71.9%, 78.5%) 66.4% (63.9%, 68.9%) 1997-2000 surviving five years 1-year 1997-2000 84.4% (81.6%, 87.3%) 66.0% (63.5%, 68.6%) 2001-2003 80.7% (77.1%, 84.3%) 70.2% (67.3%, 73.0%) compared to 49.8% of those aged
65 and over (p<0.001). (Tab. 8.3) 1993-1996 50.0% (46.1%, 53.9%) 45.7% (42.5%, 48.9%) 5-year 1997-2000 62.8% (58.9%, 66.7%) 49.8% (46.5%, 53.0%) Both one-year and five-year relative survival improved for 15-64 year olds during 1993-1996 and 1997-2000 while there were no statistically significant changes for 65-99 year olds. In particular, for males and females diagnosed in 1997- 2000, five-year relative survival among those aged 55-64 was higher than for those diagnosed in 1993- 1996 with increases of 19.4% in males (p=0.007) and 17.9% in females (p=0.012). (Tab. 8.3; Fig. 8.4)
Figure 8.4: Relative survival from cancer of the colon by age, sex and period of diagnosis (1993-2003) (a) One-year (b) Five-year
100% 1993-1996 1997-2000 2001-2003 100% 1993-1996 1997-2000
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40%
Relative survival (%) 30% Relative survival (%) 30%
20% 20%
10% 10%
0% 0% Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female 15-44 45-54 55-64 65-74 75+ 15-44 45-54 55-64 65-74 75+ Sex and Age Sex and Age
Figure 8.5: Estimated relative survival (period analysis) from cancer 8.3: Period Analysis of the colon for patients diagnosed in 2001-2004 compared with actual relative survival (cohort analysis) for patients diagnosed in Five-year survival for patients diagnosed 1997-2000. with cancer of the colon in 2001-2004 100% cannot be derived using traditional 90% methods (cohort analysis) but can be estimated using newer techniques 80%
(period analysis). Using this method five- 70% year survival from this cancer for males 60% diagnosed in 2001-2004 was 52.3% while for females it was 56.3%. This 50% does not represent a significant 40%
difference between the two sexes Relative survival (%) 30% (p>0.05). (Fig. 8.5; App. 7) 20% Male (97-00: Cohort analysis) Female (97-00: Cohort analysis) Changes in relative survival for males 10% Male (01-04: Period analysis) Female (01-04: Period analysis) and females diagnosed in 2001-2004 0% 00 01 02 03 04 05 compared with 1997-2000 were not Time since diagnosis (years)
42
Cancer of the colon statistically significant. However compared with 1993-1996 there were improvements in female five-year survival, although increases in male survival were not statistically significant. Caution should be exercised with this result as the methods used to derive the 2001-2004 survival rates are estimates only. (Fig. 8.5; App. 7)
8.4: International Comparisons EUROCARE-3 study Survival from cancer of the colon in Northern Ireland was similar to the other countries in the UK for patients diagnosed in the early 1990s, with a higher five-year relative survival rate among females than in Wales. Survival in Northern Ireland was similar to that in Europe, however the five-year age-standardised relative survival rate for males was significantly below that of France, Spain and Sweden, while the female rate was significantly below that of nine European countries including France, Germany, Italy and Spain. (Fig. 8.6)
Figure 8.6: Comparison of five-year age-standardised relative survival from cancer of the colon with other European countries (a) Male (b) Female
Northern Ireland Northern Ireland Austria Austria Czech Republic Czech Republic Denmark Denmark England England Estonia Estonia Finland Finland France France Germany Germany Iceland Iceland Italy Italy Malta Malta Netherlands Netherlands Norway Norway European country European country European Poland Poland Portugal Portugal Scotland Scotland Slovakia Slovakia Slovenia Slovenia Spain Spain Sweden Sweden Switzerland Switzerland Wales Wales EUROPE EUROPE
0% 10% 20% 30% 40% 50% 60% 70% 80% 0% 10% 20% 30% 40% 50% 60% 70% 80% Five-year relative survival (%) Five-year relative survival (%)
Source: EUROCARE-3 (2003) 27,28
Other countries Table 8.4: Five-year relative survival from cancer of the Comparisons between Northern Ireland and other colon for various countries Period of countries illustrate that survival from cancer of the Country Male Female colon was lower in Northern Ireland than in USA and diagnosis Northern Ireland 1997-2000 53.5% 53.9% Australia. (Tab. 8.4) USA 1996-2002 65.2% 62.4%
Canada 1995-1997 - - 8.5: Summary and Discussion Australia 1992-1997 58.3% 58.7% New Zealand 1994-1999 - - Cancer of the colon makes up 62% of male and 69% of female colorectal cancers in Northern Ireland and is one of the more common cancers. Incidence and mortality rates from this cancer are however falling although due to the ageing of the population the number of cases has remained static.
Northern Ireland Cancer Registry 43
Survival of cancer patients in Northern Ireland: 1993-2004
Survival from the disease in Northern Ireland is moderate with approximately 53% of persons still alive after five-years. Evidence exists of improvements in survival although these improvements occur mostly in those aged 15-64 whose survival is generally better than those aged 65 and over. Survival in Northern Ireland appears to be similar to the rest of the UK but is worse than in many European countries, USA and Canada.
See chapter 7 for information on the risks and causes of cancer of the colon.
44
Cancer of the rectum, rectosigmoid junction & anus
09: CANCER OF THE RECTUM, RECTOSIGMOID JUNCTION & ANUS (C19-C21) KEY FACTS: • 204 male and 146 newly diagnosed female cases per year between 2000 and 2004 with no significant change in male or female incidence rates during 1993-2004; • 71 male and 59 female deaths per year during 2000-2004 with no significant change in male or female mortality rates between 1993 and 2004; • Survival similar in males and females: 49.2% of males and 51.2% of females alive after five years with no significant change in survival between 1993-1996 and 1997-2000; • One-year survival better for those aged 15-64 than for those aged 65 and over; • Survival similar to rest of UK and Europe, but worse than in USA and Australia.
9.1: Incidence and Mortality Incidence The number of cases of cancer of the rectum, rectosigmoid junction and anus between 2000 and 2004 was higher among males than females with 204 male cases (4.5% of all male cancers) diagnosed annually compared to 146 female cases Table 9.1: Incidence and mortality: Cancer of the rectum, rectosigmoid junction (3.2% of all female cancers). & anus (2000-2004) (Tab. 9.1) Incidence Mortality Male Female Male Female Mortality Number of cases/deaths per year 204 146 71 59 Percentage of all cancers 4.5% 3.2% 3.8% 3.3% Deaths from cancer of the Median age at diagnosis/death 68 71 71 75 rectum, rectosigmoid junction Male to female ratio 1.4:1 - 1.2:1 - and anus made up 3.8% of male Incidence to mortality ratio 2.9:1 2.5:1 - - and 3.3% of female cancer Crude rate per 100,000 persons 24.6 16.8 8.6 6.8 deaths, with 71 male and 59 European age-standardised rate 25.0 13.8 8.5 5.2 female deaths occurring per 100,000 persons (95% CI) (23.5,26.6) (12.8,14.9) (7.6,9.4) (4.5,5.8) annually during 2000-2004. (Tab. 9.1)
Trends No significant trends in male or female incidence rates (EASIR) existed for cancer of the rectum, rectosigmoid junction & anus during 1993-2004 (p>0.05). However due to the ageing of the population the number of new cases rose over the 1993-2004 period by 3.4 male and 1.1 female cases each year. (Fig. 9.1; App. 4&6)
Mortality rates (EASMR) were static in 1993-2004 with the actual number of deaths increasing by 1.6 male and 0.9 female deaths each year. (Fig. 9.1; App. 5&6)
Figure 9.1: Incidence and mortality trends: Cancer of the rectum, rectosigmoid junction & anus (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
35 35 Male Male Female Female 30 30
25 25
20 20 persons 15 persons 15
10 10
5 5 Age standardised mortality rate per 100,000 rate standardised mortality Age Age standardised incidence rate per 100,000 per Agestandardised incidence rate
0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
Northern Ireland Cancer Registry 45
Survival of cancer patients in Northern Ireland: 1993-2004
9.2: Relative Survival Relative survival from cancer of the rectum, rectosigmoid junction & anus was 77.1% after one year for patients diagnosed in 2001-2003 and 50.1% after five years for patients diagnosed in 1997-2000. (Tab. 9.2)
Table 9.2: Relative survival from cancer of the rectum, rectosigmoid junction & anus by sex and period of diagnosis (1993-2003) Survival time and RELATIVE SURVIVAL (95% CI) period of diagnosis Males Females All persons ALL PATIENTS 1993-1996 72.9% (69.3%, 76.5%) 73.6% (69.6%, 77.7%) 73.2% (70.5%, 75.9%) 1-year 1997-2000 76.4% (72.8%, 80.0%) 80.1% (76.4%, 83.9%) 78.0% (75.4%, 80.6%) 2001-2003 78.5% (74.8%, 82.1%) 75.2% (70.6%, 79.7%) 77.1% (74.3%, 80.0%)
1993-1996 53.6% (49.3%, 57.8%) 50.4% (45.6%, 55.2%) 52.2% (49.0%, 55.4%) 3-year 1997-2000 57.3% (52.9%, 61.6%) 59.6% (54.7%, 64.4%) 58.3% (55.0%, 61.5%)
1993-1996 46.6% (42.0%, 51.1%) 42.8% (37.8%, 47.8%) 44.9% (41.6%, 48.3%) 5-year 1997-2000 49.2% (44.4%, 54.0%) 51.2% (46.0%, 56.5%) 50.1% (46.6%, 53.6%)
7-year 1993-1996 41.7% (36.9%, 46.4%) 40.5% (35.3%, 45.8%) 41.2% (37.7%, 44.7%)
PATIENTS SURVIVING AT LEAST ONE YEAR (ONE-YEAR CONDITIONAL SURVIVAL) 1993-1996 72.9% (68.4%, 77.4%) 68.0% (62.7%, 73.3%) 70.8% (67.3%, 74.2%) 3-year* 1997-2000 74.4% (69.8%, 78.9%) 73.9% (69.0%, 78.8%) 74.1% (70.8%, 77.5%)
1993-1996 62.9% (57.6%, 68.1%) 57.2% (51.3%, 63.1%) 60.4% (56.5%, 64.3%) 5-year* 1997-2000 63.5% (58.1%, 68.9%) 63.1% (57.4%, 68.9%) 63.3% (59.4%, 67.3%)
7-year* 1993-1996 56.0% (50.2%, 61.7%) 53.8% (47.5%, 60.1%) 55.0% (50.8%, 59.3%) * from diagnosis Sex There were no statistically significant differences in relative survival between males and females (p>0.05) diagnosed with cancer of the rectum, rectosigmoid junction & anus during 1993-2003. (Tab. 9.2; Fig. 9.2)
Changes over time There were no statistically significant changes in male or female one or five-year relative survival for patients diagnosed with cancer of the rectum, rectosigmoid junction & anus between 1993 and 2003 (p>0.05). (Tab. 9.2; Fig. 9.2)
Figure 9.2: Relative survival from cancer of the rectum, Figure 9.3: Relative survival from cancer of the rectum, rectosigmoid junction & anus by sex and period of rectosigmoid junction & anus by period of diagnosis and diagnosis (1993-2000) whether or not patients survive at least one year (1993- 2000) 100% 100%
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40%
Relative survival (%) 30% Relative survival (%) 30%
20% Male (93-96) 20% All (93-96) Female (93-96) Survived one-year (93-96) 10% Male (97-00) 10% All (97-00) Female (97-00) Survived one-year (97-00) 0% 0% 00 01 02 03 04 05 00 01 02 03 04 05 Time since diagnosis (years) Time since diagnosis (years)
46
Cancer of the rectum, rectosigmoid junction & anus
Conditional survival For patients diagnosed with cancer of the rectum, rectosigmoid junction & anus in 1997-2000 who were alive one-year after diagnosis 63.3% survived five-years from diagnosis. This proportion did not vary by sex or period of diagnosis (p>0.05). Seven-year survival for patients diagnosed in 1993-1996 who survived at least one-year from diagnosis was 55.0%. (Tab. 9.2; Fig. 9.3)
Age Table 9.3: Relative survival from cancer of the rectum, rectosigmoid junction For patients diagnosed with this & anus by age and period of diagnosis (1993-2003) cancer between 2001 and 2003 Survival time and RELATIVE SURVIVAL (95% CI) one-year relative survival among period of diagnosis Aged 15-64 Aged 65-99 those aged 15-64 was 10.4% 1993-1996 81.4% (77.5%, 85.3%) 69.1% (65.6%, 72.6%) better than for those aged 65-99 1-year 1997-2000 87.1% (83.6%, 90.5%) 73.3% (69.8%, 76.8%) 2001-2003 83.5% (79.6%, 87.4%) 73.1% (69.2%, 77.0%) (p=0.009). There was no significant difference in five-year relative 1993-1996 50.3% (45.2%, 55.5%) 42.2% (37.8%, 46.6%) 5-year survival (p>0.05). (Tab. 9.3) 1997-2000 56.1% (50.8%, 61.3%) 46.9% (42.2%, 51.6%)
There were no changes in relative survival for either 15-64 or 65-99 year olds over time (p>0.05). However five-year relative survival for females aged 15-44 did improve (p=0.043) between 1993-1996 and 1997- 2000 although this was based upon a small number of cases. (Tab. 9.3; Fig. 9.4)
Figure 9.4: Relative survival from cancer of the rectum, rectosigmoid junction & anus by age, sex and period of diagnosis (1993-2003) (a) One-year (b) Five-year
100% 1993-1996 1997-2000 2001-2003 100% 1993-1996 1997-2000
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40%
Relative survival (%) 30% Relative survival (%) 30%
20% 20%
10% 10%
0% 0% Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female 15-44 45-54 55-64 65-74 75+ 15-44 45-54 55-64 65-74 75+ Sex and Age Sex and Age
Figure 9.5: Estimated relative survival (period analysis) from cancer 9.3: Period Analysis of the rectum, rectosigmoid junction & anus for patients diagnosed in Five-year survival from cancer of the 2001-2004 compared with actual relative survival (cohort analysis) for patients diagnosed in 1997-2000. rectum, rectosigmoid junction & anus for 100% patients diagnosed in 2001-2004 derived using the period analysis approach to 90% reflect more recent survival experiences, 80% was 51.7% for males and 50.8% for 70% females. The difference between males and females was not statistically 60% significant (p<0.05). (Fig. 9.5; App. 7) 50%
40% Neither estimate constituted a significant Relative survival(%) 30% change from the actual five-year relative 20% survival of those diagnosed in 1997- Male (97-00: Cohort analysis) Female (97-00: Cohort analysis) 2000, although it should be emphasised 10% Male (01-04: Period analysis) Female (01-04: Period analysis) that the results are not directly 0% comparable. (Fig. 9.5; App. 7) 00 01 02 03 04 05 Time since diagnosis (years)
Northern Ireland Cancer Registry 47
Survival of cancer patients in Northern Ireland: 1993-2004
9.4: International Comparisons EUROCARE-3 study The five-year age-standardised relative survival rate for males diagnosed in 1993-1996 was 45.6% while for females the rate was 44.5%. For both sexes this was not significantly different than the five-year relative survival rate in Europe. Comparisons between Northern Ireland and other European countries included in the EUROCARE-3 study showed lower survival in Northern Ireland for both males and females than in the Netherlands and Sweden and for females than in France, Spain, Norway and Switzerland. Survival was better in Northern Ireland than in Estonia, Poland, Slovenia and Slovakia. (Fig. 9.6)
Figure 9.6: Comparison of five-year age-standardised relative survival from cancer of the rectum, rectosigmoid junction & anus with other European countries (a) Male (b) Female
Northern Ireland Northern Ireland Austria Austria Czech Republic Czech Republic Denmark Denmark England England Estonia Estonia Finland Finland France France Germany Germany Iceland Iceland Italy Italy Malta Malta Netherlands Netherlands Norway Norway
European country Poland European country Poland Portugal Portugal Scotland Scotland Slovakia Slovakia Slovenia Slovenia Spain Spain Sweden Sweden Switzerland Switzerland Wales Wales EUROPE EUROPE
0% 10% 20% 30% 40% 50% 60% 70% 80% 0% 10% 20% 30% 40% 50% 60% 70% 80% Five-year relative survival (%) Five-year relative survival (%)
Source: EUROCARE-3 (2003) 27,28
Other countries Table 9.4: Five-year relative survival from cancer of the rectum, rectosigmoid junction & anus for various countries Survival from cancer of the rectum, rectosigmoid Period of Country Male Female junction and anus was lower in Northern Ireland diagnosis than in Australia and USA for patients diagnosed Northern Ireland 1997-2000 49.2% 51.2% with the disease in the late 1990s. (Tab. 9.4) USA 1996-2002 64.7% 65.6% Canada 1995-1997 - - Australia 1992-1997 56.6% 60.6% 9.5: Summary and Discussion New Zealand 1994-1999 - - Cancer of the rectum, rectosigmoid junction and anus makes up 38% of male and 31% of female colorectal cancers in Northern Ireland with incidence and mortality rates from this cancer remaining static over time. Survival from the disease in Northern Ireland is moderate at approximately 77% of all persons alive one-year from diagnosis and 50% of persons still alive after five-years. There is little conclusive evidence of improvement in survival over time either by sex or age. Survival in Northern Ireland however appears to be similar to the rest of the UK and most European countries but is worse than in USA and Canada.
See chapter 7 for information on the risks and causes of cancer of the rectum.
48
Liver cancer
10: LIVER CANCER (C22) KEY FACTS: • 31 male and 20 female cases per year between 2000 and 2004 with no significant change in male or female incidence rates between 1993 and 2004; • 39 male and 39 female deaths per year between 2000 and 2004 with no significant change in male or female mortality rates between 1993 and 2004; • Survival similar in males and females: 12.9% of males and 24.4% of females alive after one year, with no significant change in survival over time; • Survival in Europe and other countries also poor.
10.1: Incidence and Mortality Incidence Between 2000 and 2004 an average of 31 males and 20 females were diagnosed with liver cancer each year. It was the nineteenth most common male and twentieth most common female cancer representing less than 1% of all cancers for Table 10.1: Incidence and mortality: Liver cancer (2000-2004) each sex. (Tab. 10.1) Incidence Mortality Male Female Male Female Mortality Number of cases/deaths per year 31 20 39 39 Liver cancer was the thirteenth Percentage of all cancers 0.7% 0.4% 2.1% 2.2% most common cancer death Rank 19 20 13 10 Median age at diagnosis/death 69 72 73 74 among males and tenth among Male to female ratio 1.6:1 - 1.0:1 - females with an average of 39 Incidence to mortality ratio 0.8:1 0.5:1 - - males and 39 females having Crude rate per 100,000 persons 3.7 2.3 4.7 4.5 died each year during 2000- European age-standardised rate 3.8 1.8 4.7 3.6 2004 from the disease. The per 100,000 persons (95% CI) (3.2,4.4) (1.5,2.2) (4.0,5.3) (3.0,4.1) incidence to mortality ratio for each sex was less than one indicating that more deaths than cases of liver cancer occurred during the period. This can occur when cancers spread from a different part of the body to the liver, with liver cancer thus a secondary cancer that is subsequently accredited as the cause of death. (Tab. 10.1)
Trends Trends in both incidence (EASIR) and mortality (EASMR) rates for males and females were not statistically significant (p>0.05). (Fig. 10.1; App. 4, 5&6)
The actual number of cases for males was also static during the period, however the number of females cases dropped by an average of just over one case per year. Deaths from liver cancer were fairly constant over the twelve-year period. (Fig. 10.1; App. 4, 5&6)
Figure 10.1: Incidence and mortality trends: Liver cancer (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
10 10 Male Male 9 Female 9 Female
8 8
7 7
6 6
5 5 persons persons 4 4
3 3
2 2
1 1 Age per 100,000 standardised rate mortality Age standardised incidencerate per 100,000
0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
Northern Ireland Cancer Registry 49
Survival of cancer patients in Northern Ireland: 1993-2004
10.2: Relative Survival Relative survival from liver cancer was very poor with 16.9% of patients diagnosed between 2001 and 2003 surviving one year and 5.9% of patients diagnosed between 1997 and 2000 surviving three years. Prior to this period 4.2% of persons diagnosed between 1993 and 1996 were alive after five years. Less than 10 persons diagnosed with liver cancer during 1997-2000 survived five-years (Tab. 10.2)
Table 10.2: Relative survival from liver cancer by sex and period of diagnosis (1993-2003) Survival time and RELATIVE SURVIVAL (95% CI) period of diagnosis Males Females All persons ALL PATIENTS 1993-1996 19.7% (12.0%, 27.5%) 13.5% (6.4%, 20.6%) 16.8% (11.5%, 22.2%) 1-year 1997-2000 21.5% (13.1%, 29.9%) 16.4% (8.8%, 24.0%) 19.0% (13.3%, 24.6%) 2001-2003 12.9% (5.4%, 20.4%) 24.4% (11.2%, 37.6%) 16.9% (10.1%, 23.6%)
1993-1996 <10 patients <10 patients 6.2% (2.6%, 9.7%) 3-year 1997-2000 <10 patients <10 patients 5.9% (2.3%, 9.4%)
1993-1996 <10 patients <10 patients 4.2% (1.2%, 7.3%) 5-year 1997-2000 <10 patients <10 patients <10 patients
Sex There were no significant differences Figure 10.2: Relative survival from liver cancer by sex and period of in relative survival from liver cancer diagnosis (1993-2000) 100% between males and females (p>0.05) Male (93-96) during 1993-2003. (Tab. 10.2; Fig. 90% Female (93-96) 10.2) Male (97-00) 80% Female (97-00)
70% Changes over time 60% Relative survival from liver cancer did not vary significantly by period of 50% diagnosis during 1993-2003 (p>0.05). 40% (Tab. 10.2; Fig. 10.2) Relative survival (%) 30% 20% 10.3: International Comparisons 10% EUROCARE-3 study 0% Insufficient data (i.e. less than 10 00 01 02 03 04 05 cases) exists to create a five-year Time since diagnosis (years) age-standardised relative survival rate for males and females diagnosed between 1993 and 1996 in Northern Ireland. Figure 10.3 illustrates the survival from liver cancer among countries included in the EUROCARE-3 study where sufficient data exists for an analysis of this cancer. Survival from this cancer was poor in all countries with Spain being the only country with survival greater than 10%. (Fig. 10.3)
10.4: Summary and Discussion Liver cancer is one of the less common cancers but has a poor prognosis with 6% of patients surviving three years. Incidence and mortality rates in Northern Ireland are similar to those in the rest of the UK, however while no trend in either has been detected in Northern Ireland, in Great Britain rates of new cases of liver cancer and liver cancer deaths have been increasing since the 1970s32,35. Five-year survival rates in England and Wales have improved slightly over the last thirty years but still remain poor55.
Cirrhosis is the strongest predisposing risk factor of liver cancer which can be caused by liver fluke infection and alcohol56. Infection with Hepatitis B or Hepatitis C can also cause liver cancer as it causes cirrhosis,
50
Liver cancer
Figure 10.3: Comparison of five-year age-standardised relative survival from liver cancer with other European countries (a) Male (b) Female
Northern Ireland Northern Ireland Austria Austria Czech Republic Czech Republic Denmark Denmark England England Estonia Estonia Finland Finland France France Germany Germany Iceland Iceland Italy Italy Malta Malta Netherlands Netherlands Norway Norway European country European country European Poland Poland Portugal Portugal Scotland Scotland Slovakia Slovakia Slovenia Slovenia Spain Spain Sweden Sweden Switzerland Switzerland Wales Wales EUROPE EUROPE
0% 5% 10% 15% 20% 0% 5% 10% 15% 20% Five-year relative survival (%) Five-year relative survival (%)
Source: EUROCARE-3 (2003) 27,28 Note: Missing entries due to unavailable data more so among those who smoke57. Vaccination of high-risk individuals for Hepatitis infection reduces the risk of liver cancer.
Aflatoxin B1 which are products of aspergillus fungi and accumulate during storage of grains and peanuts and occur as a food contaminant in hot, humid countries also causes liver cancer57. The accumulation of aflatoxin in stored food is not a problem in Northern Ireland.
Northern Ireland Cancer Registry 51
Survival of cancer patients in Northern Ireland: 1993-2004
11: PANCREATIC CANCER (C25) KEY FACTS: • 76 male and 84 female cases per year between 2000 and 2004 with no significant change in male or female incidence rates between 1993 and 2004; • 82 male and 89 female deaths per year between 2000 and 2004 with no significant change in male or female mortality rates between 1993 and 2004; • No difference in survival between males and females; 11.3% of males and 10.8% of females alive after one year with no change in survival over time; • Survival broadly similar to that in Europe.
11.1: Incidence and Mortality Incidence Pancreatic cancer accounted for 1.7% of male and 1.9% of female cancers diagnosed in 2000-2004. It was the thirteenth most common male cancer with an average of 76 cases diagnosed each year and the tenth most common among females Table 11.1: Incidence and mortality: Pancreatic cancer (2000-2004) with 84 cases diagnosed annually. (Tab. 11.1) Incidence Mortality Male Female Male Female
Number of cases/deaths per year 76 84 82 89 Mortality Percentage of all cancers 1.7% 1.9% 4.4% 5.0% There was an average of 82 Rank 13 10 6 5 Median age at diagnosis/death 71 74 72 75 male and 89 female deaths from Male to female ratio 0.9:1 - 0.9:1 - pancreatic cancer each year Incidence to mortality ratio 0.9:1 0.9:1 - - during 2000-2004. This Crude rate per 100,000 persons 9.1 9.7 9.9 10.2 represented 4.4% of male and European age-standardised rate 9.2 7.3 9.9 7.4 5.0% of female cancer deaths, per 100,000 persons (95% CI) (8.3,10.1) (6.6,8.0) (9.0,10.9) (6.7,8.2) with pancreatic cancer the sixth most common male and fifth most common female cancer death. As with liver cancer the incidence to mortality ratio for each sex was less than one with more deaths than cases of pancreatic cancer having occurred. This is a result of cancers other than pancreatic cancer spreading from the primary site to the pancreas, resulting in pancreatic cancer as a secondary cancer that is then recorded as the cause of death if the patient dies. (Tab.11.1)
Trends Incidence rates (EASIR) for pancreatic cancer for both sexes were static in 1993-2004 (p>0.05). Female cases however increased by an average of one per year. (Fig. 11.1; App. 4&6)
There were no significant trends in mortality rates (EASMR) for this cancer in 1993-2004 (p>0.05), although there was an increase of approximately one death each year for both sexes. (Fig. 11.1; App. 5&6)
Figure 11.1: Incidence and mortality trends: Pancreatic cancer (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
16 16
14 14
12 12
10 10
8 8 persons persons 6 6
4 4
2 2
Male per 100,000 rate standardised mortality Age Male Age standardised incidence per 100,000 rate Female Female 0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
52
Pancreatic cancer
11.2: Relative Survival Relative survival from pancreatic cancer was very poor with 11.1% of patients diagnosed between 2001 and 2003 surviving one year and 2.5% of patients diagnosed between 1997 and 2000 surviving three years, while less than 10 patients survived five years or more. Prior to this period 2.7% of patients diagnosed in 1993-1996 were alive after five years. (Tab. 11.2)
Table 11.2: Relative survival from pancreatic cancer by sex and period of diagnosis (1993-2003) Survival time and RELATIVE SURVIVAL (95% CI) period of diagnosis Males Females All persons ALL PATIENTS 1993-1996 11.9% (7.9%, 15.8%) 10.5% (6.7%, 14.2%) 11.2% (8.5%, 13.9%) 1-year 1997-2000 9.9% (6.1%, 13.7%) 13.3% (9.1%, 17.6%) 11.7% (8.8%, 14.5%) 2001-2003 11.3% (7.0%, 15.6%) 10.8% (6.8%, 14.9%) 11.1% (8.1%, 14.0%)
1993-1996 <10 patients <10 patients 2.9% (1.4%, 4.4%) 3-year 1997-2000 <10 patients <10 patients 2.5% (1.0%, 3.9%)
1993-1996 <10 patients <10 patients 2.7% (1.2%, 4.2%) 5-year 1997-2000 <10 patients <10 patients <10 patients
Sex There were no statistically significant Figure 11.2: Relative survival from pancreatic cancer by sex and period differences in relative survival for males of diagnosis (1993-2000) and females (p>0.05) diagnosed with 100% Male (93-96) pancreatic cancer between 1993 and 90% Female (93-96) 2003. (Tab. 11.2; Fig. 11.2) Male (97-00) 80% Female (97-00)
70% Changes over time 60% There were no statistically significant changes in relative survival for patients 50% diagnosed with pancreatic cancer 40% between 1993 and 2003, with 11.1% of those diagnosed in 2001-2003 alive Relative survival (%) 30% after one year compared to 11.7% of 20% those diagnosed in 1997-2000 10% (p>0.05). (Tab. 11.2; Fig. 11.2) 0% 00 01 02 03 04 05 Time since diagnosis (years) 11.3: International Comparisons EUROCARE-3 study Less than 10 males and females diagnosed in 1993-1996 in Northern Ireland survived five-years or more. International comparisons can therefore not be made due to lack of information. Figure 11.3 illustrates the situation in Europe in the early 1990s where the five-year relative survival from pancreatic cancer was approximately 4% for males and females. This was broadly similar to the five-year relative survival rate for all persons in Northern Ireland, although this figure is not age-standardised and is therefore not directly comparable. (Fig. 11.3)
Table 11.3: Five-year relative survival from Other countries pancreatic cancer for various countries Most countries have sufficient cases to allow accurate Period of Country Male Female calculation of five-year relative survival rates for diagnosis pancreatic cancer. Globally the situation in the late Northern Ireland 1993-1996 2.7% 1990s was poor with the best five-year relative survival USA 1996-2002 5.1% 4.9% rate reported in Canada for females (7.0%). (Tab. 11.3) Canada 1995-1997 6.0% 7.0% Australia 1992-1997 5.4% 5.2% New Zealand 1994-1999 6.0% 4.8%
Northern Ireland Cancer Registry 53
Survival of cancer patients in Northern Ireland: 1993-2004
Figure 11.3: Comparison of five-year age-standardised relative survival from pancreatic cancer with other European countries (a) Male (b) Female
Northern Ireland Northern Ireland Austria Austria Czech Republic Czech Republic Denmark Denmark England England Estonia Estonia Finland Finland France France Germany Germany Iceland Iceland Italy Italy Malta Malta Netherlands Netherlands Norway Norway European country European
European country European Poland Poland Portugal Portugal Scotland Scotland Slovakia Slovakia Slovenia Slovenia Spain Spain Sweden Sweden Switzerland Switzerland Wales Wales EUROPE EUROPE
0% 5% 10% 15% 20% 0% 5% 10% 15% 20% Five-year relative survival (%) Five-year relative survival (%)
Source: EUROCARE-3 (2003) 27,28
11.4: Summary and Discussion Levels of pancreatic cancer in Northern Ireland are similar to those in other UK countries35. Since the 1970s male incidence rates in the UK have fallen with a drop of 5% between 1997 and 2003. Female rates have remained steady during this period with mortality rates following a similar pattern31.
Cigarette smoking is associated with 30% of all pancreatic cancers58 while an unhealthy diet with low levels of fruit and vegetables and high fat and sugar intake can also increase risk59,60. Alcohol consumption, low levels of physical exercise and being overweight may increase the risk of developing pancreatic cancer by a small amount although studies are inconclusive and there is further work required in this area60. An increased risk may also come from frequent exposure to chlorinated hydrocarbon solvents which are found in paints, glue and dry cleaning solutions60. A link has been established between pancreatic cancer and medical conditions such as chronic pancreatitis, diabetes and stomach ulcers60. Hereditary diseases such as hereditary pancreatitis also increase risk and a genetic link is suspected in 1 in 10 pancreatic cancer cases60.
Survival rates in pancreatic cancer patients are low with only 11% surviving one year and 3% surviving five years, a similar situation to that found in other countries. The survival is due to the aggressive nature of the tumour, the usually late detection of the disease and the location of the pancreas in the body, which makes surgical intervention unfeasible in the majority of cases, particularly if the cancer has spread beyond the pancreas. Surgical intervention improves survival over the short term but has little impact on long-term survival. Similarly, improvements in palliative care have improved one-year survival rates since the 1970s in England and Wales but have not had a significant impact on long-term survival55.
54
Cancer of the larynx
12: CANCER OF THE LARYNX (C32) KEY FACTS: • 48 male and 12 female cases per year between 2000 and 2004 with decreasing male (-3.0% p.a.) incidence rates and no significant change in female incidence rates between 1993 and 2004; • 16 male and 5 female deaths per year between 2000 and 2004 with no significant change in male or female mortality rates between 1993 and 2004; • Survival similar in males and females: 69.6% of males and 57.9% of females alive after five years with no change in survival between 1993-1996 and 1997-2000; • Survival better than Poland and Slovakia and similar to other European countries, USA and Canada.
12.1: Incidence and Mortality Incidence During 2000-2004 cancer of the larynx was more common in males than females with 48 cases diagnosed per year among males compared to 12 among females. It was the seventeenth commonest cancer among males (1.1% of male cancers), Table 12.1: Incidence and mortality: Cancer of the larynx (2000-2004) compared to the twenty-second most common cancer among Incidence Mortality Male Female Male Female females. (Tab. 12.1) Number of cases/deaths per year 48 12 16 5 Percentage of all cancers 1.1% 0.3% 0.9% 0.3% Mortality Rank 17 22 17 21 Median age at diagnosis/death 65 60 70 70 Male deaths from laryngeal Male to female ratio 3.9:1 - 3.4:1 - cancer outnumbered female Incidence to mortality ratio 2.9:1 2.6:1 - - deaths with 16 male compared Crude rate per 100,000 persons 5.8 1.4 2.0 0.6 to 5 female deaths per year. European age-standardised rate 6.1 1.4 2.0 0.5 Laryngeal cancer was the per 100,000 persons (95% CI) (5.3,6.8) (1.0,1.8) (1.6,2.5) (0.3,0.7) seventeenth commonest cause of cancer death among men, making up 0.9% of male cancer deaths, while 0.3% of cancer deaths among females were as a result of this cancer. (Tab. 12.1)
Trends Male incidence rates (EASIR) for laryngeal cancer decreased during 1993-2004 by 3.0% each year (p=0.017), which corresponded to a decrease of just under one case per year. No significant trend in female EASIRs existed (p>0.05) with the actual number of newly diagnosed cases each year also static. (Fig. 12.1; App. 4&6)
There was no significant trend in male or female mortality rates for cancer of the larynx over the 1993 to 2004 period (p>0.05). The average change in the number of deaths each year was close to zero. (Fig. 12.1; App. 5&6)
Figure 12.1: Incidence and mortality trends: Cancer of the larynx (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
12 12 Male Male Female Female
10 10
8 8
6 6 persons persons
4 4
2 2 Age standardised mortality rate per 100,000 rate per Agemortality standardised Age standardised incidence per 100,000rate
0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
Northern Ireland Cancer Registry 55
Survival of cancer patients in Northern Ireland: 1993-2004
12.2: Relative Survival Relative survival from cancer of the larynx was good with 86.1% of patients diagnosed between 2001 and 2003 surviving one-year and 67.4% of patients diagnosed between 1997 and 2000 surviving five years. (Tab. 12.2)
Table 12.2: Relative survival from cancer of the larynx by sex and period of diagnosis (1993-2003) Survival time and RELATIVE SURVIVAL (95% CI) period of diagnosis Males Females All persons ALL PATIENTS 1993-1996 81.1% (75.2%, 87.0%) 83.5% (72.1%, 94.8%) 81.6% (76.3%, 86.8%) 1-year 1997-2000 90.8% (86.2%, 95.4%) 73.1% (59.8%, 86.3%) 87.5% (82.9%, 92.1%) 2001-2003 87.6% (81.5%, 93.7%) 79.8% (65.7%, 94.0%) 86.1% (80.5%, 91.8%)
1993-1996 67.5% (60.0%, 75.0%) 61.2% (45.9%, 76.4%) 66.3% (59.6%, 73.0%) 3-year 1997-2000 72.4% (65.2%, 79.6%) 64.8% (49.8%, 79.8%) 71.0% (64.5%, 77.5%)
1993-1996 62.0% (53.7%, 70.2%) 59.9% (43.7%, 76.2%) 61.6% (54.2%, 68.9%) 5-year 1997-2000 69.6% (61.6%, 77.6%) 57.9% (41.6%, 74.2%) 67.4% (60.1%, 74.6%)
Sex There were no statistically significant Figure 12.2: Relative survival from cancer of the larynx by sex and differences in one or five-year relative period of diagnosis (1993-2000) survival for males and females (p>0.05) 100% diagnosed with cancer of the larynx 90% between 1993 and 2003. (Tab. 12.2; 80% Fig. 12.2) 70% Changes over time 60% There were no statistically significant 50% changes in male or female one, three 40% or five-year relative survival for patients Relative survival (%) diagnosed with laryngeal cancer during 30% 20% 1993-2003 (p>0.05). (Tab. 12.2; Fig. Male (93-96) 12.2) Female (93-96) 10% Male (97-00) Female (97-00) 0% 00 01 02 03 04 05 Time since diagnosis (years) 12.3: International Comparisons EUROCARE-3 study The five-year age-standardised relative survival rate for males diagnosed in 1993-1996 was 61.9%, while for females the rate was 64.4%. For both sexes this was close to the five-year relative survival rate in Europe. There were no significant differences between Northern Ireland and other European countries detected except for differences with Poland and Slovakia, which had significantly lower male relative survival at 42.4% and 38.5% respectively (Fig. 12.3).
Other countries Comparisons between Northern Ireland and other Table 12.3: Five-year relative survival from cancer of countries illustrate that survival was similar in the larynx for various countries Northern Ireland to that in USA and Canada. (Tab. Period of Country Male Female 12.3) diagnosis Northern Ireland 1997-2000 69.6% 57.9% USA 1996-2002 65.9% 57.6% Canada 1995-1997 68.0% 63.0% Australia 1992-1997 - - New Zealand 1994-1999 - -
56
Cancer of the larynx
Figure 12.3: Comparison of five-year age-standardised relative survival from cancer of the larynx with other European countries (a) Male (b) Female
Northern Ireland Northern Ireland Austria Austria Czech Republic Czech Republic Denmark Denmark England England Estonia Estonia Finland Finland France France Germany Germany Iceland Iceland Italy Italy Malta Malta Netherlands Netherlands Norway Norway European country European country European Poland Poland Portugal Portugal Scotland Scotland Slovakia Slovakia Slovenia Slovenia Spain Spain Sweden Sweden Switzerland Switzerland Wales Wales EUROPE EUROPE
0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100% Five-year relative survival (%) Five-year relative survival (%)
Source: EUROCARE-3 (2003) 27,28
12.4: Summary and Discussion Laryngeal cancer is a less common cancer that occurs primarily in males. Survival from the disease in Northern Ireland is moderate at approximately 67% of persons still alive after five years, which is comparable to other countries throughout Europe and North America. The situation does not appear to have been improving over time with survival rates remaining at this level during the late 1990s with the number of deaths and female incidence also remaining unchanged. Male incidence rates, however, have fallen over recent years, possibly due to the change in smoking patterns.
Cigarette smoking is one of the major risks associated with cancer of the larynx, with the risk increasing as the length of time a person has smoked increases61. Alcohol consumption also increases risk with heavy drinkers having 2-5 times the risk of non drinkers of developing cancer of the larynx61. Both smoking and drinking heavily can interact to give an even higher risk than either on their own61.
Diet can also affect the risk of developing cancer of the larynx with a diet containing insufficient vitamins and minerals increasing the risk and a diet high in fresh fruit and vegetables reducing the risk61. A weakened immune system, caused for example by having a medical condition that affects the immune system such as AIDS, can increase the risk of developing laryngeal cancer61 and a possible link with human papillomavirus (HPV) has recently been reported61 although this remains to be proven. Regular exposure to certain chemicals such as wood dust, paint fumes or soot also increase the risk of developing this cancer61.
Northern Ireland Cancer Registry 57
Survival of cancer patients in Northern Ireland: 1993-2004
13: LUNG CANCER (Trachea, bronchus & lung) (C33-C34) KEY FACTS: • 539 male and 350 female cases diagnosed each year during 2000-2004 with an annual decrease of 2.4% in male and no significant change in female incidence rates during 1993-2004; • 488 male and 314 female deaths from the disease each year between 2000 and 2004 with an annual decrease of 2.2% in male and no significant change in female mortality rates during 1993-2004; • Five-year survival for patients diagnosed in 1997-2000 was 9.1% for males and 9.2% for females with one-year survival having improved by 3.3% for patients diagnosed in 1997-2000 compared to those diagnosed in 1993-1996; • Survival was better for 15-64 year olds than for 65-99 year olds and for patients with non-small cell lung cancer than for patients with small cell lung cancer; • One-year survival improved by 5.1% for patients diagnosed with non-small cell lung cancer during 1993-2003; • Five-year survival was lower in the most deprived areas than the most affluent areas of Northern Ireland; • Period analysis suggests no further improvement for patients diagnosed in 2001-2004; • Survival was lower than in USA, Canada, and Europe but was better than in Scotland for males and England for females.
13.1: Incidence and Mortality Incidence There were on average 539 male and 350 female cases of lung cancer diagnosed each year in 2000-2004. It was the third most common cancer among males and fourth among females representing 11.9% of male and 7.7% of female cancers Table 13.1: Incidence and mortality: Lung cancer (2000-2004) diagnosed during the five-year period. Age-standardised Incidence Mortality Male Female Male Female incidence rates (EASIR) among Number of cases/deaths per year 539 350 488 314 males were almost twice that of Percentage of all cancers 11.9% 7.7% 26.0% 17.6% females. (Tab. 13.1) Rank 3 4 1 1 Median age at diagnosis/death 71 71 72 72 Mortality Male to female ratio 1.5:1 - 1.6:1 - Incidence to mortality ratio 1.1:1 1.1:1 - - Lung cancer was the leading Crude rate per 100,000 persons 65.1 40.3 58.9 36.2 cause of cancer death among European age-standardised rate 65.1 33.4 58.6 29.0 males and females between per 100,000 persons (95% CI) (62.6,67.6) (31.7,35.0) (56.3,61.0) (27.5,30.5) 2000 and 2004 making up 26.0% of male and 17.6% of female cancer deaths. On average there were 488 male and 314 female deaths per year during this period with age-standardised mortality rates (EASMR) among males also twice that among females. (Tab. 13.1)
Trends Rates (EASIR) of male lung cancer fell in 1993-2004 by 2.4% per year (p=0.001), reflecting an average
Figure 13.1: Incidence and mortality trends: Lung cancer (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
100 100
90 90
80 80
70 70
60 60
50 50 persons persons 40 40
30 30
20 20
10 Male per 100,000 rate Agestandardised mortality 10 Male Age standardised incidence rate per 100,000 Female Female 0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
58
Lung cancer annual decrease of 4.0 cases per year. Female rates remained unchanged (p>0.05) but due to the ageing of the population the number of cases increased on average by 4.5 each year. (Fig. 13.1; App. 4&6)
Male mortality rates (EASMR) fell during 1993-2004 by 2.2% each year (p<0.001) representing a decrease of 3.0 deaths per year. No trend existed in female rates, however the number of female deaths increased by an average of 5.9 deaths per year. (Fig. 13.1; App. 5&6)
Geographic variation Incidence and mortality from lung cancer was higher in the 40% most deprived areas of Northern Ireland than in Northern Ireland as a whole during 1993-2004. Related to this was higher incidence and mortality from the disease in Belfast Metropolitan Area and Derry Urban Area compared to more rural areas. If lung cancer levels in all areas were the same as in the least deprived areas there would be approximately 300 fewer cases diagnosed annually. (Fig. 13.2)
Figure 13.2: Standardised incidence and mortality ratios for lung cancer by settlement and deprivation category: 1993-2004 (a) Settlement band (b) Deprivation quintile
Small village, hamlet, open countryside Least Deprived
Village
Intermediate settlement Quintile 4
Small town
Quintile 3 Medium town Settlement Band
Large town Quintile Deprivation Quintile 2
Derry Urban Area
Most Deprived Incidence Belfast Metropolitan Incidence Mortality Urban Area Mortality
20 40 60 80 100 120 140 160 180 0 20 40 60 80 100 120 140 160 180 200 Lower Standardised Ratio Higher Lower Standardised Ratio Higher
Incidence and mortality from lung cancer were higher in Belfast and Derry Local Government Districts than in Northern Ireland as a whole during 1993-2004. Lower rates were found in 14 of the 26 District Councils. (Tab. 13.2)
Table 13.2: Standardised incidence and mortality ratios for lung cancer by District Council: 1993-2004 Local Standardised Standardised Local Standardised Standardised Government Incidence Ratio Mortality Ratio Government Incidence Ratio Mortality Ratio District (95% CI) (95% CI) District (95% CI) (95% CI) Antrim 105.6 (93.1, 118.1) 105.8 (92.4, 119.2) Down 99.4 (89.4, 109.3) 97.3 (86.9, 107.7) Ards 93.4 (84.9, 102.0) 95.0 (85.8, 104.2) Dungannon 82.9 (72.2, 93.5) 80.5 (69.4, 91.6) Armagh 74.0 (64.6, 83.3) 78.1 (67.8, 88.3) Fermanagh 81.5 (72.4, 90.7) 77.4 (68.0, 86.9) Ballymena 69.1 (61.0, 77.3) 74.0 (65.0, 82.9) Larne 90.6 (77.9, 103.3) 90.8 (77.3, 104.3) Ballymoney 69.2 (56.7, 81.6) 60.9 (48.5, 73.3) Limavady 73.9 (60.5, 87.3) 73.4 (59.2, 87.6) Banbridge 76.2 (65.3, 87.1) 74.2 (62.8, 85.7) Lisburn 89.8 (82.3, 97.2) 86.6 (78.8, 94.4) Belfast 145.1 (139.8, 150.4) 143.6 (138.0, 149.2) Magherafelt 75.7 (64.1, 87.3) 74.1 (61.9, 86.3) Carrickfergus 113.0 (99.4, 126.6) 110.9 (96.6, 125.3) Moyle 106.0 (86.7, 125.3) 97.5 (77.9, 117.1) Castlereagh 99.4 (90.7, 108.1) 98.2 (89.0, 107.4) Newry & Mourne 96.5 (87.7, 105.3) 96.9 (87.6, 106.3) Coleraine 81.5 (72.3, 90.6) 84.8 (74.8, 94.7) Newtownabbey 97.7 (89.3, 106.2) 97.2 (88.2, 106.1) Cookstown 76.0 (63.5, 88.5) 76.6 (63.3, 90.0) North Down 81.1 (73.8, 88.4) 82.8 (75.0, 90.6) Craigavon 84.6 (76.4, 92.8) 87.6 (78.7, 96.4) Omagh 72.4 (62.2, 82.6) 72.0 (61.2, 82.8) Derry 124.6 (114.9, 134.4) 130.1 (119.4, 140.7) Strabane 91.0 (78.3, 103.8) 97.0 (82.9, 111.0) SIRs/SMRs in blue represent significantly lower or higher incidence or mortality than in Northern Ireland as a whole.
Northern Ireland Cancer Registry 59
Survival of cancer patients in Northern Ireland: 1993-2004
13.2: Relative Survival Relative survival from lung cancer was poor with 26.3% of patients diagnosed between 2001 and 2003 surviving one year, 9.1% of patients diagnosed between 1997 and 2000 surviving five years and 7.0% of patients diagnosed in 1993-1996 surviving seven years. (Tab. 13.3)
Table 13.3: Relative survival from lung cancer by sex and period of diagnosis (1993-2003) Survival time and RELATIVE SURVIVAL (95% CI) period of diagnosis Males Females All persons ALL PATIENTS 1993-1996 22.9% (21.1%, 24.7%) 26.0% (23.4%, 28.5%) 24.0% (22.5%, 25.5%) 1-year 1997-2000 27.2% (25.2%, 29.2%) 27.3% (24.8%, 29.8%) 27.3% (25.7%, 28.8%) 2001-2003 25.9% (23.6%, 28.3%) 26.8% (23.9%, 29.6%) 26.3% (24.5%, 28.1%)
1993-1996 9.3% (7.9%, 10.6%) 11.6% (9.7%, 13.5%) 10.1% (9.0%, 11.2%) 3-year 1997-2000 11.6% (10.1%, 13.1%) 12.0% (10.1%, 13.8%) 11.7% (10.6%, 12.9%)
1993-1996 6.9% (5.7%, 8.1%) 9.1% (7.4%, 10.9%) 7.7% (6.7%, 8.7%) 5-year 1997-2000 9.1% (7.7%, 10.5%) 9.2% (7.5%, 10.9%) 9.1% (8.0%, 10.2%)
7-year 1993-1996 6.4% (5.1%, 7.6%) 8.0% (6.3%, 9.8%) 7.0% (6.0%, 8.0%)
PATIENTS SURVIVING AT LEAST ONE YEAR (ONE-YEAR CONDITIONAL SURVIVAL) 1993-1996 39.9% (35.2%, 44.6%) 44.4% (38.6%, 50.3%) 41.7% (38.0%, 45.4%) 3-year* 1997-2000 42.3% (37.8%, 46.8%) 43.5% (38.0%, 49.1%) 42.8% (39.3%, 46.3%)
1993-1996 29.4% (24.8%, 33.9%) 34.9% (29.1%, 40.7%) 31.6% (28.0%, 35.2%) 5-year* 1997-2000 33.0% (28.4%, 37.6%) 33.3% (27.8%, 38.7%) 33.1% (29.6%, 36.6%)
7-year* 1993-1996 27.1% (22.4%, 31.7%) 30.5% (24.7%, 36.3%) 28.4% (24.8%, 32.1%) * from diagnosis Sex For patients diagnosed between 1993 and 2003 with lung cancer there was no significant difference in survival between males and females. For example five-year relative survival for males diagnosed in 1997- 2000 was 9.1% compared to 9.2% for females. (Tab. 13.3; Fig. 13.3)
Changes over time One-year relative survival for all persons improved for patients diagnosed in 1993-1996 compared with those diagnosed in 1997-2000, with an increase of 3.3% in those surviving one-year (p=0.036). This increase was driven primarily by a 4.3% increase in male one-year survival (p=0.028), with no significant change in female survival occurring between the two time periods. (Tab. 13.3; Fig. 13.3) Figure 13.3: Relative survival from lung cancer by sex Figure 13.4: Relative survival from lung cancer by period and period of diagnosis (1993-2000) of diagnosis and whether or not patients survive at least one year (1993-2000) 100% 100% Male (93-96) All (93-96) 90% Female (93-96) 90% Survived one-year (93-96) Male (97-00) All (97-00) 80% Female (97-00) 80% Survived one-year (97-00)
70% 70%
60% 60%
50% 50%
40% 40% Relative survival(%) 30% Relative survival (%) 30%
20% 20%
10% 10%
0% 0% 00 01 02 03 04 05 00 01 02 03 04 05 Time since diagnosis (years) Time since diagnosis (years)
60
Lung cancer
There were no statistically significant changes over time in male or female five-year relative survival for patients diagnosed with lung cancer during 1993-2003 (p>0.05). (Tab. 13.3; Fig. 13.3)
Conditional survival 27.3% of patients diagnosed with lung cancer in 1997-2000 were alive one-year from diagnosis. Of these patients 33.1% survived a further four years (i.e. five-years in total). There were no differences in this conditional survival between sexes or over time during 1993-2003 (p>0.05). (Tab. 13.3; Fig. 13.4)
Age Relative survival from lung cancer Table 13.4: Relative survival from lung cancer by age and period of during 1993-2003 was higher for those diagnosis (1993-2003) aged 15-64 than 65-99. The difference Survival time and RELATIVE SURVIVAL (95% CI) in five-year relative survival between period of diagnosis Aged 15-64 Aged 65-99 the two age groups for those 1993-1996 28.8% (26.0%, 31.6%) 21.8% (20.1%, 23.6%) diagnosed in 1997-2000 was 3.8% 1-year 1997-2000 35.2% (32.1%, 38.2%) 23.9% (22.1%, 25.7%) (p=0.028). (Tab. 13.4) 2001-2003 31.9% (28.5%, 35.3%) 23.9% (21.8%, 26.0%)
1993-1996 10.1% (8.2%, 12.0%) 6.5% (5.4%, 7.7%) One-year relative survival for those 5-year 1997-2000 11.8% (9.7%, 14.0%) 8.0% (6.7%, 9.3%) aged 15-64 increased from 28.8% for those diagnosed in 1993-1996 to 35.2% for those diagnosed in 1997-2000 (p=0.031). Changes in survival for those aged 65-99 were not statistically significant (p>0.05) nor were any changes in specific male and female age groups. (Tab. 13.4; Fig. 13.5; App. 8)
Figure 13.5: Relative survival from lung cancer by age, sex and period of diagnosis (1993-2003) (a) One-year (b) Five-year
100% 1993-1996 1997-2000 2001-2003 100% 1993-1996 1997-2000
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40%
Relative survival (%) 30% Relative survival (%) 30%
20% 20%
10% 10%
0% 0% Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female 15-44 45-54 55-64 65-74 75+ 15-44 45-54 55-64 65-74 75+ Sex and Age Sex and Age Note: Missing entries refer to less than 10 persons in that age/sex group
Deprivation and urban/rural factors Deprivation has been shown in section 13.1 (Fig. 13.2b) to be associated with lung cancer risk. Deprivation is also a factor in lung cancer survival with five-year relative survival for patients diagnosed with lung cancer during 1993-2000 who resided in the 20% most affluent areas in Northern Ireland being 11.2% compared to 7.4% for those who resided in the 20% most deprived areas in Northern Ireland (p=0.040). If survival rates in all areas equated to those in the most affluent areas, approximately 25 additional persons diagnosed annually would survive at least five-years. (Fig. 13.6)
Variations in one and five-year relative survival from lung cancer also existed between different settlement types. In particular five-year relative survival in intermediate settlements was very low at 3.9%, which was significantly lower than the 9.2% in Belfast Metropolitan Area (p=0.015) and the 8.9% in the most rural areas of Northern Ireland (p=0.044). (Fig. 13.6)
Northern Ireland Cancer Registry 61
Survival of cancer patients in Northern Ireland: 1993-2004
Figure 13.6: Relative survival from lung cancer by deprivation quintile and settlement band (1993-2000) (a) Deprivation quintile (b) Settlement band
1-year Belfast Metropolitan 1-year Area Most deprived 5-year 5-year
Derry Urban Area
Quintile 2 Large town
Medium town Quintile 3 Small town Settlement band Deprivation quintile Deprivation Quintile 4 Intermediate settlement
Village
Least deprived Small village, hamlet and open countryside
0% 5% 10% 15% 20% 25% 30% 35% 40% 0% 5% 10% 15% 20% 25% 30% 35% 40% Relative survival (%) Relative survival (%)
Cell type 50% of patients diagnosed with lung Figure 13.7: Relative survival from lung cancer by cell type (1997-2000) cancer in 1993-2003 were recorded as 100% Non-small cell having non-small cell lung cancer 90% Small cell (NSCLC) with a further 11% with small- Non-microscopically verified cell lung cancer (SCLC). The 80% remainder had a cancer type that was 70% not microscopically verified (NMV). 60% Relative survival from lung cancer depended upon the cell-type with 50% relative survival for patients diagnosed 40%
with NSCLC being higher than for (%) survival Relative 30% those diagnosed with SCLC. (Tab. 13.5; Fig. 13.7) 20%
10% One-year relative survival improved for 0% patients diagnosed with NSCLC during 00 01 02 03 04 05 1993-2003 with an increase from Time since diagnosis (years) 30.7% for patients diagnosed between 1993 and 1996 to 35.7% for patients diagnosed between 2000 and 2003 (p=0.050). No further changes in one or five-year relative survival were statistically significant. (Tab. 13.5; Fig. 13.7)
Table 13.5: Relative survival from lung cancer by cell type and period of diagnosis (1993-2003) RELATIVE SURVIVAL (95% CI) Survival time and period of diagnosis Non-small cell Small cell Non-microscopically lung cancer lung cancer verified 1993-1996 30.7% (28.5%, 32.9%) 20.7% (16.6%, 24.8%) 14.5% (12.4%, 16.7%) 1-year 1997-2000 34.5% (32.3%, 36.8%) 18.2% (14.2%, 22.1%) 18.6% (16.3%, 21.0%) 2001-2003 35.7% (32.9%, 38.6%) 26.2% (20.8%, 31.6%) 15.9% (13.6%, 18.2%)
1993-1996 11.1% (9.5%, 12.7%) 3.6% (1.6%, 5.6%) 3.6% (2.4%, 4.9%) 5-year 1997-2000 13.5% (11.7%, 15.2%) 3.1% (1.2%, 5.0%) 4.1% (2.7%, 5.4%)
13.3: Observed Survival One-year observed survival (which takes into account deaths from all causes and therefore is lower than relative survival) from lung cancer was 25.0% for male and 26.1% for female patients diagnosed between 2001 and 2003. Five-year observed survival was 7.4% for male and 8.0% for female patients diagnosed between 1997 and 2000. (Tab. 13.6)
62
Lung cancer
Table 13.6: Observed survival from lung cancer by sex and period of diagnosis (1993-2003) Survival time and OBSERVED SURVIVAL (95% CI) period of diagnosis Males Females All persons 1993-1996 21.9% (20.2%, 23.7%) 25.3% (22.8%, 27.7%) 23.1% (21.7%, 24.6%) 1-year 1997-2000 26.1% (24.2%, 28.1%) 26.6% (24.2%, 29.0%) 26.3% (24.8%, 27.8%) 2001-2003 25.0% (22.8%, 27.2%) 26.1% (23.3%, 28.9%) 25.4% (23.7%, 27.2%)
1993-1996 5.6% (4.6%, 6.5%) 8.0% (6.4%, 9.5%) 6.4% (5.6%, 7.3%) 5-year 1997-2000 7.4% (6.2%, 8.6%) 8.0% (6.5%, 9.5%) 7.6% (6.7%, 8.6%)
13.4: Period Analysis Five-year survival from lung cancer for Figure 13.8: Estimated relative survival (period analysis) from lung patients diagnosed in 2001-2004 cancer for patients diagnosed in 2001-2004 compared with actual relative survival (cohort analysis) for patients diagnosed in 1997-2000. cannot be derived using traditional 100% methods (cohort analysis) but can be Male (97-00: Cohort analysis) estimated using newer techniques 90% Female (97-00: Cohort analysis) (period analysis). Using this method Male (01-04: Period analysis) 80% Female (01-04: Period analysis) five-year survival from lung cancer for males diagnosed in 2001-2004 was 70%
8.1% while for females it was 10.1%. 60% This does not represent a significant 50% difference between the two sexes (p>0.05). (Fig. 13.8; App. 7) 40% Relative survival (%) survival Relative 30% While not directly comparable to the cohort analysis this does not constitute 20% a significant difference from five-year 10% relative survival for patients diagnosed 0% in 1997-2000 (p>0.05). (Fig. 13.8; App. 00 01 02 03 04 05 Time since diagnosis (years) 7)
13.5: International Comparisons EUROCARE-4 study For males and females relative survival was significantly lower in Northern Ireland than in Europe during 1995-1999. This difference was driven by significantly lower survival in Northern Ireland than in Austria, Belgium, France, and Italy for both sexes, than in Germany and the Netherlands for males and than in Switzerland for females. Male survival was better in Northern Ireland than in Scotland while female survival was better than in England and Denmark. (Fig. 13.9)
Other countries Table 13.7: Five-year relative survival from lung cancer for various countries Five-year relative survival from lung cancer in Period of Country Male Female Northern Ireland for those diagnosed in 1997-2000 diagnosis for both males and females was lower than that in Northern Ireland 1997-2000 9.1% 9.2% USA, Canada and Australia but was similar to that in USA 1996-2002 13.1% 17.2% New Zealand. (Tab. 13.7) Canada 1995-1997 14.5% 17.5% Australia 1992-1997 11.0% 14.0% New Zealand 1994-1999 9.5% 11.1% 13.6: Summary and Discussion Lung cancer is one of the most common cancers in Northern Ireland and is the leading cause of cancer death in both males and females. The most common symptoms of lung cancer include frequent coughing, shortness of breath, coughing up phlegm with signs of blood in it, an ache or pain when breathing or coughing, loss of appetite, fatigue and weight loss62.
Cigarette smoking is implicated in more than 90% of lung cancer cases, with the length of time that a person has smoked being the most important factor63,64. The number of cigarettes smoked per day and the
Northern Ireland Cancer Registry 63
Survival of cancer patients in Northern Ireland: 1993-2004
Figure 13.9:Comparison of five-year age-standardised relative survival from lung cancer with other European countries (a) Male (b) Female
Northern Ireland Northern Ireland Austria Austria Belgium Belgium Czech Czech Denmark Denmark Finland Finland France France Germany Germany Iceland Iceland Ireland Ireland Italy Italy Malta Malta Netherlands Netherlands Norway Norway European country European country European Poland Poland Portugal Portugal Slovenia Slovenia Spain Spain Sweden Sweden Switzerland Switzerland UK_England UK_England UK_Scotland UK_Scotland UK_Wales UK_Wales Europe Europe
0% 5% 10% 15% 20% 25% 0% 5% 10% 15% 20% 25% Five-year relative survival (%) Five-year relative survival (%)
Source:EUROCARE-4 (2007)29 type of cigarette (e.g. filtered or low tar) are also secondary factors. Breathing in secondhand cigarette smoke also increases the risk of developing lung cancer but not as much as first-hand smoking65. Other factors associated with lung cancer are exposure to asbestos, radon gas and industrial products such as arsenic, zinc, nickel, uranium, chromium and polycyclic hydrocarbons66. Past lung diseases that have caused scarring of the lung, such as tuberculosis, also increase the risk of getting lung cancer63.
Survival from the disease is very poor with less than 10% of patients surviving five years or more. However, this can depend on many different factors such as age and type of lung cancer with survival better for younger patients and for patients with non-small cell lung cancer as opposed to small-cell lung cancer.
64
Malignant melanoma
14: MALIGNANT MELANOMA (C43) KEY FACTS: • 92 male and 133 female cases per year between 2000 and 2004 with increasing male and female incidence rates (+3.5% p.a. for males during 1993-2004 and +5.1% p.a. for females during 1998-2004); • 20 male and 16 female deaths per year with increasing male (+7.3% p.a.) and decreasing female (-3.5% p.a.) mortality rates between 1993 and 2004; • Five–year survival similar in males and females: 85.8% for males and 95.3% for females diagnosed between 1997 and 2000, with no significant change in survival between 1993-1996 and 1997-2000; • No significant difference in survival by age, however survival worse for patients diagnosed at an advanced stage; • Period analysis suggests that five-year survival for patients diagnosed in 2001-2004 was better for females than men; • Survival better than in Europe and England and Wales but similar to Scotland, USA, and Australia.
14.1: Incidence and Mortality Incidence Malignant melanoma was the tenth commonest male cancer in 2000-2004 with an annual average of 92 cases making up 2.0% of all male cases. It was more frequent among females with an average of 133 females diagnosed annually with Table 14.1: Incidence and mortality: Malignant melanoma (2000-2004) the disease in 2000-2004. This made up 2.9% of female Incidence Mortality Male Female Male Female cancers and was the eighth Number of cases/deaths per year 92 133 20 16 commonest female cancer Percentage of all cancers 2.0% 2.9% 1.0% 0.9% during the five-year period. (Tab. Rank 10 8 16 18 14.1) Median age at diagnosis/death 60 59 63 74 Male to female ratio 0.7:1 - 1.2:1 - Mortality Incidence to mortality ratio 4.7:1 8.1:1 - - Crude rate per 100,000 persons 11.1 15.3 2.4 1.9 Mortality from malignant European age-standardised rate 11.4 14.1 2.5 1.5 melanoma was higher among per 100,000 persons (95% CI) (10.3,12.4) (13.0,15.2) (2.0,3.0) (1.1,1.8) males than females with 20 male and 16 female deaths per year during 2000 to 2004. It was the sixteenth commonest cause of cancer death among males and eighteenth among females. (Tab. 14.1)
Trends Incidence rates (EASIR) for malignant melanoma among males increased between 1993 and 2004 by 3.5% each year (p=0.003) while there was no significant change in EASIRs for females in 1993-1998. Since that time female incidence rates have increased by 5.1% each year (p=0.008). Increases in rates corresponded to an average increase of 3.8 male cases each year in 1993-2004 and 6.1 female cases each year in 1998- 2004. (Fig. 14.1; App. 4&6)
Figure 14.1: Incidence and mortality trends: Malignant melanoma (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
20 20 Male Male
18 Female 18 Female
16 16
14 14
12 12
10 10 persons persons 8 8
6 6
4 4
2 100,000 rate per mortality Age standardised
Age standardised incidence rate per 100,000 Age standardised incidence rate 2
0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
Northern Ireland Cancer Registry 65
Survival of cancer patients in Northern Ireland: 1993-2004
Male mortality rates (EASMR) for malignant melanoma increased annually during 1993-2004 by 7.3% (p<0.001). Female EASMRs decreased during the period by 3.5% each year (p=0.030). This represented an average of one additional male death each year while the number of female deaths remained fairly constant during the twelve-year period. (Fig. 14.1; App. 5&6)
14.2: Relative Survival Relative survival from malignant melanoma was excellent with one-year relative survival for patients diagnosed in 2001-2003 being 96.6% and five-year relative survival being 91.8% for patients diagnosed between 1997 and 2000. (Tab. 14.2)
Table 14.2: Relative survival from malignant melanoma by sex and period of diagnosis (1993-2003) Survival time and RELATIVE SURVIVAL (95% CI) period of diagnosis Males Females All persons ALL PATIENTS 1993-1996 97.1% (94.3%, 100.0%) 98.1% (96.3%, 100.0%) 97.8% (96.2%, 99.3%) 1-year 1997-2000 95.9% (92.7%, 99.1%) 97.2% (95.0%, 99.3%) 96.7% (94.9%, 98.5%) 2001-2003 93.7% (90.1%, 97.3%) 98.4% (96.5%, 100.4%) 96.6% (94.7%, 98.4%)
1993-1996 88.5% (83.4%, 93.6%) 93.1% (89.8%, 96.5%) 91.4% (88.6%, 94.3%) 3-year 1997-2000 89.9% (84.9%, 95.0%) 93.9% (90.5%, 97.3%) 92.4% (89.5%, 95.3%)
1993-1996 86.5% (80.6%, 92.4%) 91.5% (87.5%, 95.5%) 89.7% (86.3%, 93.0%) 5-year 1997-2000 85.8% (79.4%, 92.2%) 95.3% (91.4%, 99.3%) 91.8% (88.3%, 95.2%)
7-year 1993-1996 82.9% (76.2%, 89.7%) 91.8% (87.4%, 96.3%) 88.6% (84.8%, 92.3%)
PATIENTS SURVIVING AT LEAST ONE YEAR (ONE-YEAR CONDITIONAL SURVIVAL) 1993-1996 90.8% (86.3%, 95.3%) 94.6% (91.7%, 97.4%) 93.2% (90.7%, 95.6%) 3-year* 1997-2000 93.4% (89.1%, 97.7%) 96.2% (93.4%, 99.0%) 95.2% (92.8%, 97.5%)
1993-1996 88.2% (82.8%, 93.7%) 92.5% (88.9%, 96.2%) 90.9% (87.9%, 94.0%) 5-year* 1997-2000 88.7% (82.8%, 94.6%) 97.3% (93.9%, 100.7%) 94.1% (91.0%, 97.2%)
7-year* 1993-1996 84.4% (78.0%, 90.8%) 92.5% (88.3%, 96.6%) 89.5% (86.0%, 93.0%) * from diagnosis Sex There were no statistically significant differences in one or five-year relative survival for males and females (p>0.05) diagnosed with malignant melanoma between 1993 and 2003. (Tab. 14.2; Fig. 14.2)
Figure 14.2: Relative survival from malignant melanoma Figure 14.3: Relative survival from malignant melanoma by sex and period of diagnosis (1993-2000) by period of diagnosis and whether or not patients survive at least one year (1993-2000) 100% 100%
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40%
Relative survival (%) 30% Relative survival (%) 30%
20% Male (93-96) 20% All (93-96) Female (93-96) Survived one-year (93-96) 10% Male (97-00) 10% All (97-00) Female (97-00) Survived one-year (97-00) 0% 0% 00 01 02 03 04 05 00 01 02 03 04 05 Time since diagnosis (years) Time since diagnosis (years)
66
Malignant melanoma
Changes over time There were no statistically significant changes in male or female one, three or five-year relative survival for patients diagnosed with malignant melanoma between 1993 and 2003 (p>0.05) with 89.7% of those diagnosed in 1993-1996 alive after five years compared to 91.8% of those diagnosed in 1997-2000 (p>0.05). (Tab. 14.2; Fig. 14.2)
Conditional survival For patients diagnosed with malignant melanoma during 1997-2000 who survived at least one-year after diagnosis 94.1% were alive five-years from original diagnosis, while seven-year survival for patients diagnosed between 1993 and 1996 who survived at least one-year after diagnosis was 89.5%. There were no significant differences in conditional survival by sex or period of diagnosis. (Tab. 14.2; Fig. 14.3)
Age Table 14.3: Relative survival from malignant melanoma by age and period Age was not a significant factor in of diagnosis (1993-2003) survival from malignant melanoma Survival time and RELATIVE SURVIVAL (95% CI) with over 96% of patients period of diagnosis Aged 15-64 Aged 65-99 diagnosed in 2001-2003 aged 15- 1993-1996 98.4% (97.2%, 99.7%) 96.4% (92.4%, 100.4%) 64 and 65-99 surviving one year. 1-year 1997-2000 98.0% (96.6%, 99.5%) 94.3% (90.1%, 98.6%) 2001-2003 96.1% (94.1%, 98.2%) 97.2% (93.7%, 100.8%) (Tab. 14.3)
1993-1996 92.9% (90.2%, 95.6%) 82.7% (73.8%, 91.7%) 5-year One-year relative survival for males 1997-2000 91.6% (88.7%, 94.6%) 92.9% (84.2%, 101.6%) aged 55-64 decreased from 99.3% to 82.4% for those diagnosed in 1997-2000 compared to 2001-2003 (p=0.024). No other changes over time were statistically significant (p>0.05). (Tab. 14.3; Fig. 14.4)
Figure 14.4: Relative survival from malignant melanoma by age, sex and period of diagnosis (1993-2003) (a) One-year (b) Five-year
100% 100%
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40% Relative survival (%) 30% Relative survival (%) 30%
20% 20%
10% 10% 1993-1996 1997-2000 2001-2003 1993-1996 1997-2000 0% 0% Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female 15-44 45-54 55-64 65-74 75+ 15-44 45-54 55-64 65-74 75+ Sex and Age Sex and Age Stage Survival from malignant melanoma was excellent for patients diagnosed at an early stage (Clark’s level II/III or Breslow depth less than 1.5mm). Survival for patients diagnosed at a more advanced stage (Breslow depth greater than 3.00mm) was significantly worse than for those diagnosed at earlier stages. (Tab. 14.4; Fig. 14.5)
Table 14.4: Relative survival from malignant melanoma by stage at diagnosis (1993-2000) RELATIVE SURVIVAL (95% CI) Clark’s Breslow 1-year 5-year 1-year 5-year level depth Level II 98.0% (93.7%,102.3%) 95.2% (87.0%,103.3%) <0.75 100.3% (99.2%,101.5%) 99.4% (96.1%,102.7%) Level III 99.9% (98.0%,101.7%) 96.9% (91.9%,101.9%) 0.75-1.50 101.8% (101.8%,101.8%) 96.5% (90.3%,102.7%) Level IV 99.6% (97.7%,101.4%) 91.1% (86.2%,96.0%) 1.51-3.00 100.1% (96.8%,103.3%) 89.9% (80.1%,99.6%) Level V 93.8% (84.4%,103.2%) 73.7% (55.3%,92.0%) 3.01+ 92.4% (86.2%,98.7%) 70.7% (59.2%,82.1%) Unstaged 90.8% (84.5%,97.1%) 78.5% (68.4%,88.5%) Unknown 89.8% (83.2%,96.5%) 76.7% (66.4%,87.0%)
Northern Ireland Cancer Registry 67
Survival of cancer patients in Northern Ireland: 1993-2004
Figure 14.5: Relative survival from malignant melanoma by stage at diagnosis (1993-2000) (a) Clark’s level (b) Breslow depth
100% 100%
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40%
Relative survival (%) 30% Relative survival (%) Level II 30% <=0.75 Level III 0.76-1.50 20% 20% Level IV 1.51-3.00 10% Level V 10% 3.01+ Unstaged Unknown 0% 0% 00 01 02 03 04 05 00 01 02 03 04 05 Time since diagnosis (years) Time since diagnosis (years)
14.3: Observed Survival One-year observed survival (which takes into account deaths from all causes and therefore is lower than relative survival) from malignant melanoma was 91.2% for male and 96.1% for female patients diagnosed between 2001 and 2003. Five-year observed survival was 73.4% for male and 84.2% for female patients diagnosed between 1997 and 2000, a significant difference of 10.8% (p=0.019). (Tab. 14.5)
Table 14.5: Observed survival from malignant melanoma by sex and period of diagnosis (1993-2003) Survival time and OBSERVED SURVIVAL (95% CI) period of diagnosis Males Females All persons 1993-1996 94.6% (91.8%, 97.3%) 96.1% (94.2%, 97.9%) 95.5% (94.0%, 97.0%) 1-year 1997-2000 93.1% (90.0%, 96.1%) 94.8% (92.7%, 96.9%) 94.1% (92.4%, 95.9%) 2001-2003 91.2% (87.7%, 94.7%) 96.1% (94.2%, 98.0%) 94.2% (92.4%, 96.0%)
1993-1996 76.0% (70.8%, 81.2%) 82.4% (78.8%, 86.0%) 80.0% (77.0%, 83.0%) 5-year 1997-2000 73.4% (68.0%, 78.9%) 84.2% (80.7%, 87.7%) 80.1% (77.1%, 83.2%)
14.4: Period Analysis Figure 14.6: Estimated relative survival (period analysis) from Five-year relative survival from malignant malignant melanoma for patients diagnosed in 2001-2004 compared with actual relative survival (cohort analysis) for patients diagnosed melanoma for patients diagnosed in 2001- in 1997-2000.
2004 derived using the period analysis 100% approach, in order to reflect more recent survival experiences, was 82.0% for 90% males and 96.7% for females illustrating 80% significantly better survival among 70% females than males (p<0.05). (Fig. 14.6; 60% App. 7) 50%
Neither estimate constituted a significant 40% change from the actual five-year relative (%) survival Relative 30% survival of those diagnosed in 1997-2000, 20% Male (97-00: Cohort analysis) although it should be emphasised that the Female (97-00: Cohort analysis) results are not directly comparable. (Fig. 10% Male (01-04: Period analysis) Female (01-04: Period analysis) 14.6; App. 7) 0% 00 01 02 03 04 05 Time since diagnosis (years) 14.5: International Comparisons EUROCARE-4 study Based upon the age-standardised results of the EUROCARE-4 study survival for males and females diagnosed in Northern Ireland with malignant melanoma in the late 1990s was higher than in Europe as a
68
Malignant melanoma
Figure 14.7:Comparison of five-year age-standardised relative survival from malignant melanoma with other European countries (a) Male (b) Female
Northern Ireland Northern Ireland Austria Austria Belgium Belgium Czech Czech Denmark Denmark Finland Finland France France Germany Germany Iceland Iceland Ireland Ireland Italy Italy Malta Malta Netherlands Netherlands Norway Norway European country European country European Poland Poland Portugal Portugal Slovenia Slovenia Spain Spain Sweden Sweden Switzerland Switzerland UK_England UK_England UK_Scotland UK_Scotland UK_Wales UK_Wales EUROPE EUROPE
0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100% Five-year relative survival (%) Five-year relative survival (%)
Source:EUROCARE-4 (2007)29 whole and than in many individual European countries including England, Wales, Italy, Spain, Poland, Austria, Czech Republic and Belgium. Male survival was also significantly higher in Northern Ireland than in Ireland and Portugal with male and female survival similar to that in Scotland. (Fig. 14.7)
Other countries Table 14.6: Five-year relative survival from malignant Comparisons between Northern Ireland and other melanoma for various countries Period of countries illustrate that survival was good in Northern Country Male Female diagnosis Ireland being equivalent to that in USA, Australia, Northern Ireland 1997-2000 85.8% 95.3% Canada and New Zealand. (Tab. 14.6) USA 1996-2002 90.1% 93.1% Canada 1995-1997 87.0% 93.0% 14.6: Summary and Discussion Australia 1992-1997 90.0% 94.6% New Zealand 1994-1999 89.2% 94.3% Melanoma is a form of skin cancer, which in the majority of cases is caused by excessive exposure to the Sun. Melanoma usually presents as moles or lesions on the skin that can be seen to be changing size, shape or colour, are itchy or painful, bleed or are inflammed.
A reduction in the risk of developing this skin cancer can be achieved by spending time in the shade between 11am and 3pm, making sure you never burn, covering up with T shirt, hat and sunglasses and using factor 15+ sunscreen67. The use of sunbeds also causes malignant melanoma, with sunbed tans not providing any additional protection from sun exposure67.
The level of risk of developing skin cancer through over exposure to the sun or sunbeds depends upon skin type, with those with fairer skin being more at risk67. The number of moles on the skin also affects the risk of developing malignant melanoma, with the risk increasing as the number of moles increases67. A weakened immune system, some skin conditions (solar keratosis, xeroderma pigmentosum, Gorlin’s syndrome) or severe burns and skin ulcers can also increase risk67.
Northern Ireland Cancer Registry 69
Survival of cancer patients in Northern Ireland: 1993-2004
Melanoma in Northern Ireland is increasing as is mortality from the disease among males although deaths from the disease among females are decreasing. Survival from the disease is excellent for all age groups but depends greatly upon the stage at which the disease is diagnosed.
70
Mesothelioma
15: MESOTHELIOMA (C45) KEY FACTS: • 44 male and 5 female cases per year between 2000 and 2004 with no significant change in male or female incidence rates between 1993 and 2004; • 41 male and 5 female deaths per year between 2000 and 2004 with no significant change in male or female mortality rates between 1993 and 2004; • Survival very poor with 9.6% of all persons alive after three years, and no significant change in survival over time; • Similar survival to USA.
15.1: Incidence and Mortality Incidence Mesothelioma was a cancer predominantly found in males with an average of 44 males and 5 females diagnosed with mesothelioma each year between 2000 and 2004. It was the eighteenth most common male cancer making up 1.0% of Table 15.1: Incidence and mortality: Mesothelioma (2000-2004) all male cancers but was not in the top 20 of female cancers Incidence Mortality Male Female Male Female with only 0.1% of female Number of cases/deaths per year 44 5 41 5 cancers being of this type. (Tab. Percentage of all cancers 1.0% 0.1% 2.2% 0.3% 15.1) Rank 17 23 12 22 Median age at diagnosis/death 71 70 72 70 Mortality Male to female ratio 8.5:1 - 8.8:1 - Incidence to mortality ratio 1.1:1 1.1:1 - - On average 41 males died each Crude rate per 100,000 persons 5.3 0.6 4.9 0.5 year from mesothelioma European age-standardised rate 5.4 0.5 4.9 0.5 representing 2.2% of all male per 100,000 persons (95% CI) (4.7,6.1) (0.3,0.7) (4.2,5.5) (0.3,0.7) cancer deaths. It was the twelfth commonest cause of male cancer death and the twenty-second most common cause of female cancer death. (Tab. 15.1)
Trends No statistically significant trend in male incidence or mortality rates for mesothelioma existed between 1993 and 2004 (p>0.05). Due to the ageing of the population however the actual number of cases increased by 1.4 each year, while the number of deaths increased by 1.7 each year during the twelve-year period. (Fig. 15.1; App. 4,5&6)
Female incidence and mortality rates for this cancer remained in a steady state (p>0.05), with no statistically significant trends during this period. The annual change in the number of new cases and deaths also remained close to zero. (Fig. 15.1; App. 4,5&6)
Figure 15.1: Incidence and mortality trends: Mesothelioma (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
10 10 Male Male 9 Female 9 Female
8 8
7 7
6 6
5 5 persons persons 4 4
3 3
2 2
1 per 100,000 rate standardised mortality Age 1 Age standardised incidence rate per 100,000
0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
Northern Ireland Cancer Registry 71
Survival of cancer patients in Northern Ireland: 1993-2004
15.2: Relative Survival Relative survival from mesothelioma was very poor with 27.0% of patients diagnosed in 2001-2003 surviving one year and 9.6% of patients diagnosed in 1997-2000 surviving three years. Less than 10 patients diagnosed between 1997 and 2000 survived five years. (Tab. 15.2)
Table 15.2: Relative survival from Figure 15.2: Relative survival from mesothelioma by period of mesothelioma by period of diagnosis (1993- diagnosis (1993-2000) 2003)
Survival time and RELATIVE SURVIVAL 100% period of diagnosis (95% CI) (93-96) All persons 90% (97-00) 1993-1996 28.4% (20.0%, 36.7%) 80% 1-year 1997-2000 27.7% (21.1%, 34.4%) 70% 2001-2003 27.0% (19.3%, 34.7%) 60% 1993-1996 12.2% (5.9%, 18.4%) 3-year 50% 1997-2000 9.6% (5.1%, 14.1%) 40%
Relative survival (%) 1993-1996 8.0% (2.6%, 13.4%) 30% 5-year 1997-2000 - - 20%
10%
0% 00 01 02 03 04 05 Time since diagnosis (years)
Changes over time There was no statistically significant change in either one or three-year relative survival for patients diagnosed with mesothelioma between 1993 and 2003. (Tab. 15.2; Fig. 15.2)
15.3: International Comparisons Most cancer registries do not regularly produce survival rates for mesothelioma as it is a rare cancer, nor were survival probabilities for this cancer included in the EUROCARE study. However five-year relative survival in the USA was 9.2% for all persons diagnosed between 1996 and 2002. This was slightly higher than the 8.0% five-year relative survival rate in Northern Ireland for all persons diagnosed between 1993 and 1996. This difference was not statistically significant at the 95% level.
15.4: Summary and Discussion Mesothelioma is a rare cancer that occurs primarily in the lining of the lungs or abdomen. The odds of developing this form of cancer are over 1 in 400. This risk varies significantly by gender, with the majority of mesothelioma cases being diagnosed in males.
The majority of cases of mesothelioma are caused by exposure to asbestos with between 70% and 80% of persons diagnosed with this cancer indicating that they have previous contact with asbestos. The risk increases depending upon the level of exposure and the age at which exposure occurred, with exposure at earlier ages increasing the risk68.
Despite the reduction of the use of asbestos in Northern Ireland, incidence and mortality rates have yet to fall by a significant amount; in fact in Great Britain mortality from mesothelioma has been increasing since the 1960s. This is likely to be due to the long delay (approximately 15-40 years) between exposure to asbestos and the development of mesothelioma68. Given the wide use of asbestos in industry until the 1980s deaths from mesothelioma are expected to continue to increase in Great Britain until 2015, at which point a rapid decline should occur69.
Survival from mesothelioma is very poor at 10% after three years. This is similar to the situation in the USA and is due in part to symptoms of mesothelioma presenting late when the disease is already at an advanced stage and difficult to treat70.
72
Breast cancer
16: BREAST CANCER (Females only) (C50) KEY FACTS: • 996 cases diagnosed each year during 2000-2004 with an annual increase in incidence rates of 1.4% during 1993- 2004; • 297 deaths each year during 2000-2004 with an annual decrease in mortality rates of 2.6% during 1993-2004; • Five-year survival for patients diagnosed in 1997-2000 was 80.1% with five-year survival having improved by 4.6% for patients diagnosed in 1997-2000 compared to those diagnosed in 1993-1996; • Survival was better for 15-64 year olds than for 65-99 year olds and for patients with stage I and II breast cancer than for patients with stage III and IV breast cancer; • One-year survival increased for stage II patients but decreased for unstaged patients from 1997-2000 to 2001-2003; • Five-year survival was lower in the most deprived areas than the most affluent areas of Northern Ireland; • Survival was similar to that in Europe and the rest of the UK, better than in Ireland but lower than in France, Italy, USA, Canada and Australia.
16.1: Incidence and Mortality Incidence There were an average of 996 female cases of breast cancer diagnosed each year between 2000 and 2004. It was the second leading cause of female cancer (behind non-melanoma skin cancer) making up 21.9% of all female cancers. (Tab. 16.1) Table 16.1: Incidence and mortality: Breast cancer (2000-2004)
Incidence Mortality Mortality Number of cases/deaths per year 996 297 Deaths from breast cancer averaged 297 per Percentage of all cancers 21.9% 16.6% year during 2000-2004, representing 16.6% of Rank 2 2 all female cancer deaths. Breast cancer was Median age at diagnosis/death 60 69 Incidence to mortality ratio 3.4:1 - the second most common cause of female Crude rate per 100,000 persons 114.8 34.2 cancer death. (Tab. 16.1) European age-standardised rate 108.6 28.7 per 100,000 persons (95% CI) (105.5,111.7) (27.2,30.2) Trends Incidence rates (EASIR) for breast cancer increased during 1993-2004 by 1.4% each year (p=0.002). This represented an annual increase of 23.8 cases during the twelve-year period. (Fig. 16.1; App. 4&6)
Mortality rates (EASMR) for breast cancer decreased during 1993-2004 with an annual percentage change of -2.6% (p=0.003), equivalent to an annual decrease of just under 3 deaths. (Fig. 16.1; App. 5&6)
Geographic variation There was no significant relationship between deprivation, as defined by the 2005 Noble economic deprivation measure7, and incidence or mortality from breast cancer during 1993-2004. This differs from
Figure 16.1: Incidence and mortality trends: Breast cancer (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
140 140
120 120
100 100
80 80 persons persons 60 60
40 40
20 20 Age standardised mortality rate per 100,000 100,000 per rate mortality Age standardised Age standardised incidence rate per 100,000
0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
Northern Ireland Cancer Registry 73
Survival of cancer patients in Northern Ireland: 1993-2004 previous studies2 based on the 2001 Noble economic deprivation measure which showed higher levels of breast cancer in the most affluent areas of Northern Ireland. (Fig. 16.2)
There was no conclusive relationship between urban/rural factors and incidence and mortality from this disease. (Fig. 16.2)
Figure 16.2: Standardised incidence and mortality ratios for breast cancer by settlement and deprivation category: 1993-2004 (a) Settlement band (b) Deprivation quintile
Small village, hamlet, open countryside Least Deprived
Village
Intermediate settlement Quintile 4
Small town
Quintile 3 Medium town Settlement Band Settlement
Large town Deprivation Quintile Quintile 2
Derry Urban Area
Most Deprived Incidence Belfast Metropolitan Incidence Mortality Urban Area Mortality
50 60 70 80 90 100 110 120 130 140 150 50 60 70 80 90 100 110 120 130 140 150 Lower Standardised Ratio Higher Lower Standardised Ratio Higher
New cases of female breast cancer were higher than expected in Newry & Mourne Local Government District than in Northern Ireland as a whole during 1993-2004. Lower incidence rates were found in Cookstown and Lisburn. With the exception of lower mortality rates in Cookstown, there was no significant variation in mortality by District Council during 1993-2004. (Tab. 16.2)
Table 16.2: Standardised incidence and mortality ratios for breast cancer by District Council: 1993-2004 Local Standardised Standardised Local Standardised Standardised Government Incidence Ratio Mortality Ratio Government Incidence Ratio Mortality Ratio District (95% CI) (95% CI) District (95% CI) (95% CI) Antrim 95.6 (84.3, 107.0) 109.4 (87.9, 131.0) Down 98.7 (89.0, 108.4) 106.9 (89.4, 124.5) Ards 100.1 (91.5, 108.8) 102.2 (86.9, 117.5) Dungannon 105.6 (93.7, 117.4) 100.2 (79.9, 120.4) Armagh 101.6 (90.8, 112.4) 98.6 (80.0, 117.1) Fermanagh 100.4 (90.2, 110.7) 99.9 (82.2, 117.6) Ballymena 94.6 (85.2, 104.0) 94.2 (77.9, 110.5) Larne 103.3 (89.8, 116.7) 93.3 (71.1, 115.4) Ballymoney 93.4 (79.0, 107.9) 89.0 (64.3, 113.7) Limavady 107.7 (92.2, 123.2) 102.4 (75.4, 129.5) Banbridge 102.6 (90.3, 115.0) 99.3 (78.0, 120.7) Lisburn 92.3 (85.0, 99.5) 93.9 (81.1, 106.7) Belfast 97.9 (93.6, 102.3) 99.3 (91.8, 106.7) Magherafelt 103.4 (90.1, 116.8) 101.8 (78.4, 125.1) Carrickfergus 93.5 (81.4, 105.5) 89.5 (68.8, 110.2) Moyle 100.2 (81.4, 119.0) 82.1 (52.7, 111.4) Castlereagh 105.2 (96.2, 114.2) 97.5 (82.5, 112.5) Newry & Mourne 109.3 (100.2, 118.4) 115.9 (99.4, 132.4) Coleraine 100.9 (90.9, 111.0) 102.6 (85.1, 120.2) Newtownabbey 105.8 (97.2, 114.4) 112.0 (96.5, 127.5) Cookstown 78.4 (65.9, 91.0) 75.5 (53.9, 97.1) North Down 107.4 (99.1, 115.7) 95.4 (82.0, 108.8) Craigavon 99.5 (90.9, 108.2) 104.0 (88.5, 119.5) Omagh 97.6 (86.0, 109.2) 88.8 (69.4, 108.3) Derry 104.5 (96.1, 112.9) 114.1 (98.4, 129.8) Strabane 88.9 (76.4, 101.3) 80.9 (59.9, 101.9) SIRs/SMRs in blue represent significantly lower or higher incidence or mortality than in Northern Ireland as a whole.
16.2: Relative Survival Relative survival from breast cancer was good with 95.2% of patients diagnosed between 2001 and 2003 surviving one year and 80.1% of patients diagnosed during 1997-2000 surviving five years. (Tab. 16.3)
Changes over time There was a significant improvement of 4.6% in five-year relative survival for breast cancer between 1993- 1996 and 1997-2000 (p=0.010). One-year relative survival for females diagnosed with breast cancer also
74
Breast cancer improved during 1993-2003 with Table 16.3: Relative survival from breast cancer by period of diagnosis 95.2% of females diagnosed (1993-2003) RELATIVE SURVIVAL (95% CI) between 2001 and 2003 surviving Survival time and PATIENTS SURVIVING AT one year compared to 92.2% of period of diagnosis ALL PATIENTS females diagnosed between 1993 LEAST ONE YEAR 1993-1996 92.2% (91.2%, 93.3%) and 1996 (p=0.003). (Tab. 16.3; 1-year* 1997-2000 95.1% (94.2%, 95.9%) Fig. 16.3) 2001-2003 95.2% (94.3%, 96.2%)
1993-1996 81.3% (79.7%, 82.9%) 87.8% (86.5%, 89.2%) Conditional survival 3-year* 1997-2000 85.0% (83.6%, 86.5%) 89.1% (87.9%, 90.3%) For female patients diagnosed with breast cancer during 1997-2000 1993-1996 75.5% (73.7%, 77.4%) 81.2% (79.5%, 82.9%) 5-year* who survived at least one-year 1997-2000 80.1% (78.4%, 81.8%) 83.6% (82.1%, 85.2%) after diagnosis 83.6% were alive five years from original diagnosis, 7-year* 1993-1996 71.5% (69.5%, 73.5%) 76.6% (74.6%, 78.5%) while seven-year survival for * from diagnosis patients diagnosed between 1993 and 1996 who survived at least one year after diagnosis was 76.6%. This proportion did not change significantly over time. (Tab. 16.3; Fig. 16.4)
Figure 16.3: Relative survival from breast cancer by Figure 16.4: Relative survival from breast cancer by period of diagnosis (1993-2000) period of diagnosis and whether or not patients survive at least one year (1993-2000) 100% 100%
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40% Relative survival (%) Relative survival (%) 30% 30%
20% 20% All (93-96) Survived one-year (93-96) 10% 1993-1996 10% All (97-00) 1997-2000 Survived one-year (97-00) 0% 0% 00 01 02 03 04 05 00 01 02 03 04 05 Time since diagnosis (years) Time since diagnosis (years)
Age Age was a significant factor in breast Table 16.4: Relative survival from breast cancer by age and period of cancer survival with five-year relative diagnosis (1993-2003) survival for females aged 15-64 Survival time and RELATIVE SURVIVAL (95% CI) diagnosed with the disease during period of diagnosis Aged 15-64 Aged 65-99 1997-2000 being 10.7% higher than 1993-1996 96.0% (95.1%, 96.9%) 86.4% (84.2%, 88.6%) those aged 65-99 (p<0.001). 1-year 1997-2000 97.8% (97.1%, 98.4%) 91.0% (89.1%, 92.8%) Additionally one-year relative survival 2001-2003 98.3% (97.6%, 98.9%) 90.1% (87.8%, 92.3%) for those aged 75+ was significantly 1993-1996 79.9% (78.0%, 81.8%) 68.6% (65.0%, 72.2%) worse than for those aged 65-74 5-year 1997-2000 84.2% (82.5%, 85.9%) 73.5% (70.0%, 77.0%) during each period of analysis from 1993 to 2003. (Tab. 16.4; Fig. 16.5)
One-year relative survival improved for both 15-64 and 65-99 year olds from 1993-1996 to 1997-2000 (p<0.033). Five-year relative survival also improved significantly for those aged 15-64 with 79.9% of those diagnosed in 1993-1996 surviving five-years compared to 84.2% of those diagnosed in 1997-2000 (p=0.020). (Tab. 16.4; Fig. 16.5)
Northern Ireland Cancer Registry 75
Survival of cancer patients in Northern Ireland: 1993-2004
Figure 16.5: Relative survival from breast cancer by age and period of diagnosis (1993-2003) (a) One-year (b) Five-year
100% 1993-1996 1997-2000 2001-2003 100% 1993-1996 1997-2000
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40% Relative survival (%) Relative survival (%) 30% 30%
20% 20%
10% 10%
0% 0% 15-44 45-54 55-64 65-74 75+ 15-44 45-54 55-64 65-74 75+ Age Age
Deprivation and urban/rural factors Five-year relative survival from breast cancer increased with increasing affluence during 1993-2000 with five-year relative survival for patients who resided in the 20% most affluent areas in Northern Ireland being 81.3% compared to 74.6% for those who resided in the 20% most deprived areas in Northern Ireland (p=0.016). (Fig. 16.6)
Variations in one and five-year relative survival from breast cancer also existed between different settlement types with five-year relative survival in small towns at 69.2%, which was significantly lower than the 78.9% in Belfast Metropolitan Area (p=0.010) and the 77.6% in the most rural areas of Northern Ireland (p=0.033). (Fig. 16.6)
Figure 16.6: Relative survival from breast cancer by deprivation quintile and settlement band (1993-2000) (a) Deprivation quintile (b) Settlement band
Belfast Metropolitan Area Most deprived
Derry Urban Area
Quintile 2 Large town
Medium town Quintile 3
Small town Settlement band Deprivation quintile Quintile 4 Intermediate settlement
Village
Least deprived Small village, hamlet and open countryside 1-year 1-year 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 5-year 5-year Relative survival (%) Relative survival (%) Stage Relative survival from breast cancer decreased significantly with increasing stage at diagnosis during 1993- 2003. Five-year relative survival for patients diagnosed with breast cancer at Stage I in 1997-2000 was
Table 16.5: Relative survival from breast cancer by stage and period of diagnosis (1993-2003) Period of RELATIVE SURVIVAL (95% CI) Diagnosis Stage I Stage II Stage III Unstaged 1-year 1993-1996 99.4% (98.3%,100.5%) 96.5% (95.1%,97.9%) 86.4% (81.6%,91.2%) 88.3% (86.3%,90.3%) 1997-2000 100.5% (100.0%,101.1%) 98.6% (97.7%,99.6%) 90.8% (86.2%,95.3%) 88.2% (86.1%,90.3%) 2001-2003 100.3% (99.8%,100.9%) 100.3% (99.6%,101.0%) 93.5% (90.7%,96.4%) 82.1% (78.1%,86.1%) 5-year 1993-1996 98.6% (96.3%,100.8%) 78.9% (75.8%,81.9%) 50.6% (43.3%,58.0%) 68.3% (65.1%,71.4%) 1997-2000 96.3% (94.2%,98.5%) 81.5% (78.8%,84.2%) 55.0% (46.9%,63.2%) 70.7% (67.5%,74.0%) Note: Stage IV omitted from table due to insufficient number of cases 76
Breast cancer
96.3% compared to 55.0% for Stage III. Figure 16.7: Relative survival from breast cancer by stage (1997- Less than 10 patients diagnosed at stage 2000) IV survived five years although the 100% Stage 1 number of cases diagnosed at this stage 90% was small. (Tab.16.5; Fig.16.7) 80% Stage 2
70% 32% of patients diagnosed in 1997-2000 Unstaged did not have a stage assigned. Survival 60% for these patients was average with Stage 3 50% 88.2% surviving one-year and 70.7% surviving five-years. (Tab.16.5; Fig.16.7) 40%
(%) survival Relative 30%
There were no significant improvements 20% in five-year relative survival by stage during 1993-2003, however one-year 10% relative survival increased for those with 0% 00 01 02 03 04 05 stage II disease but decreased for Time since diagnosis (years) unstaged patients between 1997-2000 and 2001-2003. (Tab. 16.5) Table 16.6: Observed survival from breast cancer by sex and period of diagnosis (1993-2003) 16.3: Observed Survival Survival time and OBSERVED SURVIVAL One-year observed survival (which takes into account period of diagnosis (95% CI) deaths from all causes and therefore is lower than relative survival) was 93.3% for female patients diagnosed with 1993-1996 90.2% (89.2%, 91.2%) breast cancer between 2001 and 2003. Five-year 1-year 1997-2000 93.0% (92.2%, 93.8%) 2001-2003 93.3% (92.4%, 94.2%) observed survival was 71.7% for female patients diagnosed between 1997 and 2000. (Tab. 16.6) 1993-1996 67.5% (65.9%, 69.1%) 5-year 1997-2000 71.7% (70.2%, 73.2%)
16.4: Period Analysis Figure 16.8: Estimated relative survival (period analysis) from breast cancer for patients diagnosed in 2001-2004 compared with actual Traditional methods for producing five- relative survival (cohort analysis) for patients diagnosed in 1997- year relative survival rates (cohort 2000. analysis) require five-years worth of 100% follow up data and thus do not reflect more recent survival experience. More 90% up to date survival rates can be 80% estimated using newer techniques such 70% as period analysis. 60% Five-year survival from breast cancer for 50% females diagnosed in 2001-2004 derived 40%
using this approach was 81.6%. Caution Relative survival (%) 30% should be exercised in the interpretation of these figures, as they are not directly 20% comparable with results from traditional 10% 1997-2000 (Cohort analysis) methods, however no significant changes 2001-2004 (Period analysis) 0% in survival compared to patients 00 01 02 03 04 05 diagnosed in 1997-2000 are apparent Time since diagnosis (years) (p>0.05). (Fig. 16.8)
16.5: International Comparisons EUROCARE-4 study For females diagnosed with breast cancer in Northern Ireland during 1995-1999 the five-year age- standardised survival rate was 77.4% which was similar to the rate in Europe of 78.9%. There was
Northern Ireland Cancer Registry 77
Survival of cancer patients in Northern Ireland: 1993-2004 considerable variation in five-year survival among Figure 16.9:Comparison of five-year age-standardised the individual European countries; consequently relative survival from breast cancer with other European countries survival in Northern Ireland was higher than in some European countries, such as the Czech Republic, Northern Ireland Ireland, Poland and Slovenia, while it was similar to Austria Belgium that in other countries, such as the rest of UK, Czech Germany and Spain, and was lower than in others, Denmark such as Finland, France, Norway, Sweden, Finland Switzerland, Italy and the Netherlands. (Fig. 16.9) France Germany Iceland Other countries Ireland For patients diagnosed with breast cancer during Italy the late 1990s survival in Northern Ireland was Malta similar to that in New Zealand but was significantly Netherlands (p<0.05) lower than in USA, Canada and Australia. Norway (Tab. 16.7) European country Poland Portugal Slovenia Table 16.7: Five-year relative survival from breast cancer for various countries Spain Sweden Period of Country Switzerland diagnosis UK_England Northern Ireland 1997-2000 80.1% UK_Scotland USA 1996-2002 88.5% UK_Wales Canada 1995-1997 86.0% Europe Australia 1992-1997 84.0% New Zealand 1994-1999 81.7% 0% 20% 40% 60% 80% 100% Five-year relative survival (%)
Source:EUROCARE-4 (2007)29 16.6: Summary and Discussion Breast cancer in Northern Ireland has been increasing, which is likely due to increased detection with the breast screening program and ongoing changes in lifestyle. However breast cancer mortality is decreasing due to better treatment and earlier detection, which has resulted in a 5% improvement in five-year survival from this disease over recent years. Relative survival from this disease was 80% after five-years for patients diagnosed in 1997-2000 which is similar to Europe as a whole but is lower than some European countries and USA. Various factors influence five-year survival including age, stage at diagnosis and area of residence. Part of the explanation for these differences, such as those with Republic of Ireland, may lie in availability and uptake of breast screening which allows earlier detection, thereby increasing survival.
Increasing age is the most important risk factor for breast cancer. Personal histories of breast cancer can also increase the risk of developing a second breast cancer although the use of tamoxifen can reduce this risk71. Additionally a significant family history, such as having a mother diagnosed with breast cancer before age 40 or having two or more close relatives on the same side diagnosed with breast cancer, may result in an increased risk of developing the disease71. Approximately 5% of breast cancers are inherited via faulty genes, usually BRCA1 or BRCA2, the presence of which can significantly increase the lifetime risk of developing breast cancer. The presence of these faulty genes can be detected and are accompanied by a strong family history of breast cancer71.
Reproductive history is related to the risk of developing breast cancer. An early menarche (first period), late menopause, late first birth or nulliparity (never giving birth) all increase the risk of getting breast cancer71,72. The use of breast-feeding can have a protective effect73. Exposure to oestrogen through Hormone Replacement Therapy can also increase breast cancer risk71. There is some evidence that obesity in post- menopausal women contributes to an increased risk74, while 4-5 hours of exercise per week may have a protective effect against breast cancer although evidence is not conclusive75. Alcohol consumption is related to breast cancer, with women who do not drink having a lower risk of developing breast cancer compared to those who do. The greater the amount of alcohol consumed per week, the greater the risk of breast cancer76.
78
Cervical cancer
17: CERVICAL CANCER (C53) KEY FACTS: • 78 cases each year during 2000-2004 with an annual decrease in incidence rates of 2.5% during 1993-2004; • 29 deaths each year between 2000 and 2004 with no change in mortality rates during 1993-2004; • Five-year survival for patients diagnosed in 1997-2000 was 67.8% with no significant change in five-year survival for patients diagnosed in 1997-2000 compared to those diagnosed in 1993-1996; • Survival was better for 15-64 year olds than for 65-99 year olds and for patients with stage I cervical cancer than for patients with stage II, III and IV cervical cancer; • Survival was lower than in England, USA, Canada and Australia.
17.1: Incidence and Mortality Incidence Including micro invasive cancers, cervical cancer was the eleventh most common female cancer diagnosed between 2000 and 2004 making up 1.7% of all female cancer cases. There were 78 cases diagnosed per year during this period with a median age at diagnosis of 44. It had the second youngest Table 17.1: Incidence and mortality: Cervical cancer (2000- median age at diagnosis of the female 2004) cancers. (Tab. 17.1) Incidence Mortality Number of cases/deaths per year 78 29 Percentage of all cancers 1.7% 1.6% Rank 11 14 Mortality Median age at diagnosis/death 44 64 Twenty-nine deaths from cervical cancer Incidence to mortality ratio 2.7:1 - occurred each year between 2000 and 2004. Crude rate per 100,000 persons 9.0 3.4 This represented 1.6% of all female cancer European age-standardised rate 8.7 3.0 per 100,000 persons (95% CI) (7.9,9.6) (2.5,3.5) deaths and was ranked fourteenth as a cause of cancer mortality among females. (Tab. 17.1)
Trends Incidence rates (EASIR) for cervical cancer decreased between 1993 and 2004 by 2.5% each year (p=0.014). Mortality rates (EASMR) however remained static during this period. (Fig. 17.1; App. 4, 5&6)
Both the annual number of newly diagnosed cases and the number of deaths dropped each year by an average of 1.0 case and 0.3 deaths during the twelve-year period. (Fig. 17.1; App. 4, 5&6)
Figure 17.1: Incidence and mortality trends: Cervical cancer (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
16 16
14 14
12 12
10 10
8 8 persons persons 6 6
4 4
2 2 Age standardised mortality rate per 100,000 100,000 per rate mortality standardised Age Age standardised incidence rate per 100,000
0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
Northern Ireland Cancer Registry 79
Survival of cancer patients in Northern Ireland: 1993-2004
17.2: Relative Survival Relative survival from cervical cancer was good with 87.8% of patients diagnosed in 2001-2003 surviving one year and 67.8% of patients diagnosed in 1997-2000 surviving five years. (Tab. 17.2)
Changes over time There was no statistically significant Table 17.2: Relative survival from cervical cancer by period of diagnosis change in either one or five-year (1993-2003) RELATIVE SURVIVAL (95% CI) relative survival for patients Survival time and PATIENTS SURVIVING AT diagnosed with cervical cancer period of diagnosis ALL PATIENTS between 1993 and 2003. (Tab. LEAST ONE YEAR 1993-1996 83.1% (78.9%, 87.3%) 17.2; Fig. 17.2) 1-year* 1997-2000 83.8% (79.7%, 87.9%)
2001-2003 87.8% (83.3%, 92.2%) Conditional survival 1993-1996 67.8% (62.6%, 73.1%) 81.5% (76.7%, 86.3%) Five-year relative survival for 3-year* 1997-2000 73.0% (68.0%, 78.0%) 87.0% (82.8%, 91.2%) cervical cancer patients who survived one year from a diagnosis 1993-1996 61.8% (56.3%, 67.3%) 74.2% (68.7%, 79.7%) 5-year* in 1997-2000 was 80.7% while 1997-2000 67.8% (62.3%, 73.2%) 80.7% (75.6%, 85.8%) seven-year survival for those diagnosed in 1993-1996 was 7-year* 1993-1996 59.9% (54.3%, 65.6%) 71.9% (66.2%, 77.6%) 71.9%. This conditional survival rate * from diagnosis did not vary significantly by period of diagnosis (p>0.05). (Tab. 17.2; Fig. 17.3)
Figure 17.2: Relative survival from cervical cancer by Figure 17.3: Relative survival from cervical cancer by period of diagnosis (1993-2000) period of diagnosis and whether or not patients survive at least one year (1993-2000) 100% 100%
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40% Relative survival (%) Relative survival (%) survival Relative 30% 30%
20% 20% All (93-96) Survived one-year (93-96) 10% 1993-1996 10% All (97-00) 1997-2000 Survived one-year (97-00) 0% 0% 00 01 02 03 04 05 00 01 02 03 04 05 Time since diagnosis (years) Time since diagnosis (years)
Age Relative survival from cervical cancer Table 17.3: Relative survival from cervical cancer by age and period of was better for patients aged 15-64 diagnosis (1993-2003) than 65-99, with the difference 32.1% Survival time and RELATIVE SURVIVAL (95% CI) for those diagnosed in 1997-2000 period of diagnosis Aged 15-64 Aged 65-99 and surviving five-years. In particular 1993-1996 88.6% (84.7%, 92.5%) 62.6% (50.6%, 74.5%) five-year relative survival for patients 1-year 1997-2000 89.5% (85.7%, 93.3%) 64.0% (52.4%, 75.6%) aged 15-44 diagnosed in 1997-2000 2001-2003 93.5% (89.8%, 97.2%) 61.0% (45.0%, 77.0%) was 82.0% compared to 56.7% for 1993-1996 70.8% (65.1%, 76.5%) 26.4% (14.6%, 38.2%) those aged 65-74. (Tab. 17.3; Fig. 5-year 1997-2000 74.7% (69.2%, 80.3%) 42.6% (29.3%, 55.8%) 17.4; App. 8)
There were no significant changes in relative survival for either 15-64 or 65-99 year olds over time (p>0.05). (Tab. 17.3; Fig. 17.4)
80
Cervical cancer
Figure 17.4: Relative survival from cervical cancer by age and period of diagnosis (1993-2003) (a) One-year (b) Five-year
100% 1993-1996 1997-2000 2001-2003 100% 1993-1996 1997-2000
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40%
Relative survival (%) 30% Relative survival (%) 30%
20% 20%
10% 10%
0% 0% 15-44 45-54 55-64 65-74 75+ 15-44 45-54 55-64 65-74 75+ Age Age Note: Missing entries refer to less than 10 persons in that age/sex group
Stage Patients diagnosed with Stage I cervical cancer during 1993-2000 had a significantly higher survival probability than for those diagnosed at a later stage (p<0.001). Those diagnosed at stage II and III had similar survival, however one-year relative survival from stage IV disease was significantly lower with less than 10 patients surviving one-year. However the number of patients diagnosed at this stage was small. (Tab. 17.4; Fig. 17.5)
Table 17.4: Relative survival from Figure 17.5: Relative survival from cervical cancer by stage (1993- cervical cancer by stage (1993-2000) 2000) Survival time RELATIVE SURVIVAL 100% and stage (95% CI) 90% Stage 1
1-year 80% Stage I 99.2% (97.9%, 100.5%) 70% Stage II 70.3% (60.5%, 80.0%) 60% Stage III 75.0% (63.6%, 86.4%) Unstaged 50% Stage IV - - Stage 2 Unstaged 77.2% (71.6%, 82.8%) 40% Stage 3 5-year Relative survival(%) 30% Stage I 91.5% (87.7%, 95.3%) 20% Stage II 50.4% (39.1%, 61.6%) Stage III 39.1% (26.0%, 52.2%) 10% Stage IV - - 0% 00 01 02 03 04 05 Unstaged 51.3% (44.5%, 58.2%) Time since diagnosis (years)
17.3: Observed Survival Table 17.5: Observed survival from cervical cancer by sex One-year observed survival (which takes into and period of diagnosis (1993-2003) account deaths from all causes and therefore is Survival time and OBSERVED SURVIVAL (95% CI) lower than relative survival) was 87.2% for period of diagnosis patients diagnosed with cervical cancer between 1993-1996 82.3% (78.2%, 86.4%) 2001 and 2003. Five-year observed survival was 1-year 1997-2000 83.1% (79.0%, 87.2%) 65.4% for patients diagnosed between 1997 and 2001-2003 87.2% (82.7%, 91.6%) 2000. (Tab. 17.5) 1993-1996 59.5% (54.1%, 64.8%) 5-year 1997-2000 65.4% (60.1%, 70.6%)
Northern Ireland Cancer Registry 81
Survival of cancer patients in Northern Ireland: 1993-2004
17.4: Period Analysis Figure 17.6: Estimated relative survival (period analysis) from cervical cancer for patients diagnosed in 2001-2004 compared with actual Five-year relative survival from cervical relative survival (cohort analysis) for patients diagnosed in 1997-2000. cancer for patients diagnosed in 2001- 100% 2004 cannot be derived using traditional methods (cohort analysis) 90% but can be estimated using newer 80% techniques such as period analysis. 70%
Five-year relative survival from cervical 60% cancer for patients diagnosed in 2001- 50% 2004 derived using this approach was 69.7%. This estimate did not constitute 40% Relative survival (%) survival Relative a significant change from the actual 30% five-year relative survival of those 20% diagnosed in 1997-2000, although it should be emphasised that the results 10% 1997-2000 (Cohort analysis) 2001-2004 (Period analysis) are not directly comparable. (Fig. 17.6; 0% 00 01 02 03 04 05 App. 7) Time since diagnosis (years)
17.5: International Comparisons EUROCARE-3 study The five-year age-standardised relative survival rate Figure 17.7:Comparison of five-year age-standardised for females diagnosed with cervical cancer between relative survival from cervical cancer with other European countries 1993 and 1996 was 57.7%, which was significantly lower than that in many European countries but not Northern Ireland Europe as a whole. The European countries that Austria Czech Republic illustrated higher survival were Denmark, England, Denmark France, Italy, Netherlands, Norway, Spain and England Sweden. Survival from this disease was however Estonia better than that found in Poland. (Fig. 17.7) Finland France Germany Other countries Iceland Five-year relative survival rates in Northern Ireland Italy were similar to those in New Zealand for females Malta diagnosed with cervical cancer in the late 1990s. Netherlands Australia, Canada and USA had slightly higher Norway survival rates. (Tab. 17.6) European country Poland Portugal Scotland Table 17.6: Five-year relative survival from cervical cancer for various countries Slovakia Slovenia Period of Country Spain diagnosis Sweden Northern Ireland 1997-2000 80.1% Switzerland USA 1996-2002 88.5% Wales Canada 1995-1997 86.0% EUROPE Australia 1992-1997 84.0% New Zealand 1994-1999 81.7% 0% 20% 40% 60% 80% 100% Five-year relative survival (%) Source: EUROCARE-3 (2003) 27,28 17.6: Summary and Discussion The rate of new cases of cervical cancer in Northern Ireland has steadily decreased over the last 12 years possibly due to lifestyle factors and screening programs which identify cervical cancer before it becomes malignant. Survival from the disease is good but depends upon age and the stage at which the disease is diagnosed.
82
Cervical cancer
Infection with human papillomavirus (HPV), especially types 16 and 18, pose a high risk for the development of cervical cancer77. However most HPV infections will not progress to cervical cancer and the new HPV vaccine promises a further reduction in the development of cervical cancer as a result of this virus78. Sexual activity is indirectly related to the chance of developing cervical cancer as increased activity increases the possibility of contracting HPV or other sexually transmitted diseases78.
Cigarette smoking and poor diet are also linked to an increased risk of developing cervical cancer, although both factors only increase the risk directly by a small amount, they can increase the risk by a larger margin in combination with HPV79. Use of the contraceptive pill is also a possible risk factor, although the increase in risk is small78,80.
Northern Ireland Cancer Registry 83
Survival of cancer patients in Northern Ireland: 1993-2004
18: CANCER OF THE UTERUS (C54) KEY FACTS: • 155 cases diagnosed each year during 2000-2004 with an annual increase in incidence rates of 5.3% during 1993- 2004; • 20 deaths from the disease each year between 2000 and 2004 with no change in mortality rates during 1993-2004; • Five-year survival for patients diagnosed in 1997-2000 was 72.5% with no significant change in five-year survival for patients diagnosed in 1997-2000 compared to those diagnosed in 1993-1996; • Survival was better for 15-64 year olds than for 65-99 year olds; • Survival was lower than in Europe, England, USA and Australia.
18.1: Incidence and Mortality Incidence Cancer of the uterus represented 3.4% of all female cancer cases diagnosed between 2000 and 2004 and was the sixth most common female cancer during this period. On average 155 cases were diagnosed each year with a median age at diagnosis of 64. (Tab. 18.1) Table 18.1: Incidence and mortality: Cancer of the uterus (2000- 2004) Incidence Mortality Number of cases/deaths per year 155 20 Mortality Percentage of all cancers 3.4% 1.1% Cancer of the uterus was the sixteenth Rank 6 16 commonest cause of female cancer death Median age at diagnosis/death 64 75 between 2000 and 2004 with 20 deaths per Incidence to mortality ratio 7.9:1 - year, 1.1% of the total number of female Crude rate per 100,000 persons 17.9 2.3 deaths due to cancer. (Tab. 18.1) European age-standardised rate 16.7 1.7 per 100,000 persons (95% CI) (15.5,17.9) (1.4,2.1)
Trends Incidence rates (EASIR) for cancer of the uterus increased during the 1993 to 2004 period by 5.3% each year (p<0.001) from 10.4 to 16.0 cases per 100,000 females, corresponding to an annual increase of 7.6 cases. (Fig. 18.1; App. 4&6)
There was no significant change in mortality rates (EASMR) during 1993 to 2004 (p=0.058). However there was an annual increase of one additional death per year from this cancer during 1993-2004. (Fig. 18.1; App. 5&6)
Figure 18.1: Incidence and mortality trends: Cancer of the uterus (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
25 25
20 20
15 15 persons persons 10 10
5 5 Age standardised mortality rate per 100,000 100,000 per rate mortality standardised Age Age standardised incidence rate per 100,000 100,000 per rate incidence Age standardised
0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
84
Cancer of the uterus
18.2: Relative Survival Relative survival from cancer of the uterus was good with one-year relative survival 88.3% for patients diagnosed in 2001-2003, while five-year relative survival was 72.5% for patients diagnosed in 1997-2000. (Tab. 18.2)
Changes over time There was no statistically significant Table 18.2: Relative survival from cancer of the uterus by period of change in relative survival for diagnosis (1993-2003) RELATIVE SURVIVAL (95% CI) patients diagnosed with cancer of Survival time and PATIENTS SURVIVING the uterus between 1993 and 2003. period of diagnosis ALL PATIENTS (Tab. 18.2; Fig. 18.2) AT LEAST ONE YEAR 1993-1996 83.7% (79.6%, 87.8%)
1-year* 1997-2000 87.6% (84.3%, 90.9%) Conditional survival 2001-2003 88.3% (85.1%, 91.6%) Five-year relative survival from the 1993-1996 69.9% (64.7%, 75.2%) 83.2% (78.5%, 88.0%) date of diagnosis for cancer of the 3-year* 1997-2000 75.5% (71.1%, 79.9%) 85.9% (82.1%, 89.8%) uterus for the sub-group of patients who survived at least one-year from 1993-1996 66.1% (60.4%, 71.8%) 78.3% (72.7%, 83.9%) 5-year* diagnosis was 82.3%, while seven- 1997-2000 72.5% (67.7%, 77.3%) 82.3% (77.8%, 86.8%) year survival was 78.3%. There were no significant changes over time in 7-year* 1993-1996 66.3% (60.3%, 72.3%) 78.3% (72.3%, 84.2%) this conditional survival (p>0.05). * from diagnosis (Tab.18.2; Fig. 18.3)
Figure 18.2: Relative survival from cancer of the uterus Figure 18.3: Relative survival from cancer of the uterus by period of diagnosis (1993-2000) by period of diagnosis and whether or not patients survive at least one year (1993-2000) 100% 100%
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40% Relative survival (%) Relative survival (%) 30% 30%
20% 20% All (93-96) Survived one-year (93-96) 10% 1993-1996 10% All (97-00) 1997-2000 Survived one-year (97-00) 0% 0% 00 01 02 03 04 05 00 01 02 03 04 05 Time since diagnosis (years) Time since diagnosis (years)
Age Survival from cancer of the uterus Table 18.3: Relative survival from cancer of the uterus by age and period depended upon age in 1993-2003 of diagnosis (1993-2003) with relative survival better for those Survival time and RELATIVE SURVIVAL (95% CI) aged 15-64 than 65-99 (p<0.001). In period of diagnosis Aged 15-64 Aged 65-99 particular relative survival was higher 1993-1996 96.1% (93.0%, 99.2%) 71.4% (64.4%, 78.5%) for those aged 15-44 than 65-74 1-year 1997-2000 94.9% (91.9%, 97.9%) 80.1% (74.5%, 85.8%) (p=0.014) and 75+ (p=0.003), and 2001-2003 96.6% (94.1%, 99.1%) 79.0% (73.0%, 85.0%) decreased significantly between 1993-1996 83.8% (77.7%, 89.8%) 47.8% (38.9%, 56.7%) those aged 55-64 and 65-74 5-year 1997-2000 84.9% (79.7%, 90.0%) 59.6% (51.7%, 67.4%) (p=0.022). (Tab. 18.3; Fig. 18.4)
There was no significant change in relative survival over time for either age group. (Tab.18.3; Fig.18.4)
Northern Ireland Cancer Registry 85
Survival of cancer patients in Northern Ireland: 1993-2004
Figure 18.4: Relative survival from cancer of the uterus by age and period of diagnosis (1993-2003) (a) One-year (b) Five-year
100% 1993-1996 1997-2000 2001-2003 100% 1993-1996 1997-2000
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40% Relative survival (%) Relative survival (%) 30% 30%
20% 20%
10% 10%
0% 0% 15-44 45-54 55-64 65-74 75+ 15-44 45-54 55-64 65-74 75+ Age Age Note: Missing entries refer to less than 10 persons in that age/sex group
18.3: Observed Survival Table 18.4: Observed survival from cancer of the One-year observed survival (which takes into account uterus by sex and period of diagnosis (1993-2003) deaths from all causes and therefore is lower than relative Survival time and OBSERVED SURVIVAL survival) was 86.6% for patients diagnosed with cancer of period of diagnosis (95% CI) the uterus between 2001 and 2003. Five-year observed 1993-1996 81.7% (77.7%, 85.7%) survival was 66.0% for patients diagnosed between 1997 1-year 1997-2000 85.8% (82.7%, 89.0%) and 2000. (Tab. 18.4) 2001-2003 86.6% (83.4%, 89.8%)
1993-1996 58.9% (53.8%, 64.0%) 5-year 1997-2000 66.0% (61.6%, 70.3%) 18.4: Period Analysis Figure 18.5: Estimated relative survival (period analysis) from cancer of Five-year relative survival for patients the uterus for patients diagnosed in 2001-2004 compared with actual diagnosed in 2001-2004 with cancer of relative survival (cohort analysis) for patients diagnosed in 1997-2000 the uterus, derived using the period 100% analysis approach in order to reflect 90% more recent survival experiences, was 75.2%. (Fig. 18.5; App. 7) 80% 70% This did not constitute a significant 60% change from the actual five-year relative survival of those diagnosed in 50%
1997-2000, although it should be 40%
emphasised that the results are not Relative survival (%) 30% directly comparable due to the different methods used. (Fig. 18.5; App. 7) 20%
10% 1997-2000 (Cohort analysis) 2001-2004 (Period analysis) 0% 00 01 02 03 04 05 Time since diagnosis (years) 18.5: International Comparisons EUROCARE-3 study For females diagnosed in 1993-1996 the five-year age-standardised survival rate for cancer of the uterus was 65.1%. This was significantly lower than the equivalent survival rate of 76.0% in Europe, which was derived as part of the EUROCARE-3 study. The majority of European countries contributed to this difference with survival in Northern Ireland being similar only to Czech Republic, Estonia, Iceland, Malta, Poland and Slovakia. The largest difference was with Austria where survival was almost 20% better than in Northern Ireland. (Fig. 18.6)
86
Cancer of the uterus
Other countries Figure 18.6:Comparison of five-year age-standardised relative survival from cancer of the uterus with other Five-year relative survival rates in Northern Ireland European countries were similar to those in New Zealand for females Northern Ireland diagnosed with cancer of the uterus in the late Austria 1990s. Australia, Canada and USA had slightly Czech Republic higher survival rates. (Tab. 18.5) Denmark England Table 18.5: Five-year relative survival from Estonia cancer of the uterus for various countries Finland Period of France Country diagnosis Germany Northern Ireland 1997-2000 80.1% Iceland USA 1996-2002 88.5% Italy Canada 1995-1997 86.0% Malta Australia 1992-1997 84.0% Netherlands New Zealand 1994-1999 81.7% Norway
European country Poland Portugal 18.6: Summary and Discussion Scotland Cancer of the uterus has steadily increased in Slovakia Northern Ireland over the last twelve years, a trend Slovenia also observed in the rest of the UK35. The exact Spain Sweden reasons for this increase are unknown although Switzerland attention has focused on changes in lifestyle. Wales Females who are obese and/or have a diet high in EUROPE fat have a higher risk of developing cancer of the 0% 20% 40% 60% 80% 100% body of the uterus than females who have a Five-year relative survival (%) healthy weight and/or a balanced diet81,82. Source: EUROCARE-3 (2003) 27,28
Reproductive and menstrual history is also related to the development of cancer of the uterus. Having children is considered to be protective with the risk of endometrial cancer decreasing as the number of children given birth to increases81. A late menopause, early first period, irregular periods or longer than usual periods all increase risk81. The use of the contraceptive pill however has a protective effect81.
The use of Hormone Replacement Therapy (HRT) has been linked to a rise in endometrial cancer81, as has the use of tamoxifen, although the benefits in preventing breast cancer outweigh the risk caused by its use81,83. Endometrial hyperplasia and polycystic ovary syndrome are also linked to an increased risk of developing cancer of the uterus81. Family history is also a factor as the inheritance of a faulty HNPCC (hereditary non-polyposis colorectal cancer) gene can increase the risk of developing several types of cancer including endometrial cancer81.
Survival from the disease is good but is highly dependent upon the age of the patient with persons over 65 fairing much worse than those under 65. Survival is better in other countries than in Northern Ireland suggesting that room for improvement exists. This may be achieved by increased awareness of the disease as treatment is more effective when the disease is identified at an early stage.
Northern Ireland Cancer Registry 87
Survival of cancer patients in Northern Ireland: 1993-2004
19: OVARIAN CANCER (C56) KEY FACTS: • 191 newly diagnosed cases per year between 2000 and 2004 with incidence rates increasing by 1.4% each year between 1993 and 2004; • 116 deaths per year between 2000 and 2004 with no significant change in mortality rates between 1993 and 2004; • Survival average with 43.0% of females alive after five years with no significant change in survival between 1993- 1996 and 1997-2000; • Survival better for those aged 15-64 than for those aged 65 and over with survival high for stage I disease but very poor for stage IV disease; • Survival similar to rest of UK, Ireland, Europe and USA.
19.1: Incidence and Mortality Incidence Ovarian cancer made up 4.2% of female cancers diagnosed between 2000 and 2004 and was the fifth most common female cancer. There were on average 191 cases diagnosed per year with a median age at diagnosis of 63. (Tab. 19.1) Table 19.1: Incidence and mortality: Ovarian cancer (2000- 2004) Incidence Mortality Mortality Number of cases/deaths per year 191 116 There were on average 116 deaths per year Percentage of all cancers 4.2% 6.5% from ovarian cancer between 2000 and 2004. Rank 5 4 These deaths made up 6.5% of all female Median age at diagnosis/death 63 71 cancer deaths with ovarian cancer being the Incidence to mortality ratio 1.6:1 - fourth most common cause of female cancer Crude rate per 100,000 persons 22.0 13.4 death. The median age at death was nine European age-standardised rate 20.1 11.1 per 100,000 persons (95% CI) (18.8,21.5) (10.1,12.0) years later than at diagnosis. (Tab. 19.1)
Trends Incidence rates (EASIR) for ovarian cancer increased between 1993 and 2004 by 1.4% each year (p=0.044) from 17.9 to 21.0 cases per 100,000 females. This represented an annual increase of 5.0 cases each year. (Fig. 19.1; App. 4&6)
Mortality rates (EASMR) remained static during the period (p>0.05). Despite this the number of deaths was seen to increase by 3.4 per year during 1993-2004. (Fig. 19.1; App. 5&6)
Figure 19.1: Incidence and mortality trends: Ovarian cancer (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
30 30
25 25
20 20
15 15 persons persons
10 10
5 5 Age standardised mortality rate per 100,000 100,000 per rate mortality standardised Age Age standardised incidence rate per 100,000 100,000 per rate incidence standardised Age
0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
88
Ovarian cancer
19.2: Relative Survival Relative survival from ovarian cancer was average with 67.8% of females diagnosed in 2001-2003 surviving one year and 43.0% of patients diagnosed in 1997-2000 surviving five years. (Tab. 19.2)
Changes over time Table 19.2: Relative survival from ovarian cancer by period of diagnosis There was no statistically significant (1993-2003) RELATIVE SURVIVAL (95% CI) change in relative survival for Survival time and PATIENTS SURVIVING patients diagnosed with ovarian period of diagnosis ALL PATIENTS AT LEAST ONE YEAR cancer during 1993-2003. (Tab. 1993-1996 65.9% (61.9%, 69.9%) 19.2; Fig. 19.2) 1-year* 1997-2000 67.4% (63.8%, 71.0%) 2001-2003 67.8% (63.7%, 71.9%) Conditional survival 1993-1996 46.1% (41.9%, 50.4%) 69.6% (64.7%, 74.5%) 3-year* 67.4% of patients diagnosed with 1997-2000 50.1% (46.1%, 54.0%) 74.0% (69.8%, 78.3%) ovarian cancer in 1997-2000 were alive one-year from diagnosis. Of 1993-1996 41.6% (37.3%, 45.9%) 62.6% (57.3%, 67.9%) 5-year* these patients 63.4% survived a 1997-2000 43.0% (39.0%, 47.0%) 63.4% (58.6%, 68.2%) further four years (i.e. five years in total). There were no changes in this 7-year* 1993-1996 38.5% (34.2%, 42.9%) 57.9% (52.3%, 63.4%) conditional survival over time during * from diagnosis 1993-2003 (p>0.05). (Tab. 19.2; Fig. 19.3)
Figure 19.2: Relative survival from ovarian cancer by Figure 19.3: Relative survival from ovarian cancer by period of diagnosis (1993-2000) period of diagnosis and whether or not patients survive at least one year (1993-2000) 100% 100%
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40% Relative survival (%) Relative survival (%) survival Relative 30% 30%
20% 20% All (93-96) Survived one-year (93-96) 10% 1993-1996 10% All (97-00) 1997-2000 Survived one-year (97-00) 0% 0% 00 01 02 03 04 05 00 01 02 03 04 05 Time since diagnosis (years) Time since diagnosis (years)
Age Table 19.3: Relative survival from ovarian cancer by age and period of Relative survival from ovarian cancer diagnosis (1993-2003) was better for patients aged 15-64 Survival time and RELATIVE SURVIVAL (95% CI) than 65-99, with the difference in period of diagnosis Aged 15-64 Aged 65-99 five-year relative survival being 1993-1996 78.0% (73.3%, 82.7%) 51.6% (45.3%, 57.8%) 17.8% for those diagnosed in 1997- 1-year 1997-2000 79.5% (75.4%, 83.5%) 51.2% (45.2%, 57.1%) 2001-2003 87.3% (83.3%, 91.2%) 45.8% (39.4%, 52.2%) 2000 (p=0.002). In particular five- year relative survival for patients 1993-1996 53.6% (47.9%, 59.3%) 27.1% (21.0%, 33.3%) 5-year aged 15-44 was 73.2%, which 1997-2000 50.6% (45.5%, 55.7%) 32.8% (26.5%, 39.0%) dropped to 24.6% for those aged 75 and over diagnosed in 1997-2000 (p<0.001). (Tab. 19.3; Fig. 19.4)
There was no significant change in five-year relative survival over time for patients aged 15-64 or 65-99 (p<0.05), however one-year relative survival increased for 15-64 year olds from 78.0% for patients diagnosed in 1993-1996 to 87.3% for patients diagnosed in 2000-2003 (p=0.036). (Tab. 19.3)
Northern Ireland Cancer Registry 89
Survival of cancer patients in Northern Ireland: 1993-2004
Figure 19.4: Relative survival from ovarian cancer by age and period of diagnosis (1993-2003) (a) One-year (b) Five-year
100% 1993-1996 1997-2000 2001-2003 100% 1993-1996 1997-2000
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40% Relative survival (%) 30% Relative survival (%) 30%
20% 20%
10% 10%
0% 0% 15-44 45-54 55-64 65-74 75+ 15-44 45-54 55-64 65-74 75+ Age Age
Stage Patients diagnosed with stage I ovarian cancer during 1993-2000 had a significantly higher survival probability than for those diagnosed at stage II, III or IV (p<0.001). Survival for patients with no stage assigned was poor with five-year relative survival 32.6% for patients diagnosed in 1993-2000. (Tab. 19.4; Fig. 19.5)
Table 19.4: Relative survival from ovarian Figure 19.5: Relative survival from ovarian cancer by stage (1993-2000) cancer by stage (1993-2000) Survival time RELATIVE SURVIVAL 100% and stage (95% CI) 90%
1-year 80% Stage 1 Stage I 93.1% (90.0%, 96.3%) 70% Stage II 82.4% (74.5%, 90.3%) 60% Stage III 67.6% (61.3%, 73.9%) 50% Stage IV 55.9% (37.6%, 74.2%) Stage 2 Unstaged 51.2% (47.1%, 55.2%) 40%
5-year (%) survival Relative 30% Unstaged Stage I 83.5% (78.3%, 88.6%) 20% Stage II 37.1% (26.9%, 47.2%) Stage 3 Stage III 20.2% (14.6%, 25.8%) 10% Stage IV - 0% 00 01 02 03 04 05 Unstaged 32.6% (28.6%, 36.6%) Time since diagnosis (years)
19.3: Observed Survival Table 19.5: Observed survival from ovarian cancer by sex and Observed survival from ovarian cancer, which period of diagnosis (1993-2003) takes into account deaths from all causes, was Survival time and OBSERVED SURVIVAL moderate with 66.6% of patients diagnosed in period of diagnosis (95% CI) 2001-2003 alive after one year. Five-year 1993-1996 64.7% (60.8%, 68.6%) observed survival was 39.7% for patients 1-year 1997-2000 66.3% (62.7%, 69.8%) diagnosed in 1997-2000. (Tab. 19.5) 2001-2003 66.6% (62.6%, 70.6%)
1993-1996 38.3% (34.3%, 42.3%) 5-year 1997-2000 39.7% (36.0%, 43.4%)
90
Ovarian cancer
19.4: Period Analysis Figure 19.6: Estimated relative survival (period analysis) from ovarian cancer for patients diagnosed in 2001-2004 compared with actual relative Traditional methods (cohort analysis) survival (cohort analysis) for patients diagnosed in 1997-2000. for producing five-year relative 100% survival rates do not reflect more recent survival experience due to the 90% length of follow up required. 80% However more up to date survival 70% rates can be estimated using newer techniques such as period analysis. 60%
50% Five-year survival from ovarian cancer for patients diagnosed in 40% Relative survival (%) survival Relative 2001-2004 derived using this 30% approach was 43.6%. While not 20% directly comparable with results from traditional methods, this estimate 10% 1997-2000 (Cohort analysis) 2001-2004 (Period analysis) indicates that there was no 0% 00 01 02 03 04 05 significant change in survival Time since diagnosis (years) compared to patients diagnosed in 1997-2000 (p>0.05). (Fig. 19.6; App. 7)
19.5: International Comparisons
EUROCARE-4 study Figure 19.7:Comparison of five-year age-standardised The European age-standardised five-year relative relative survival from ovarian cancer with other European countries survival rate diagnosed in Northern Ireland with ovarian cancer during 1995-1999 was 34.0%, which Northern Ireland Austria was similar to the 36.3% for European females. Belgium Survival in Northern Ireland was similar to most Czech other European countries but was lower than in Denmark Austria and Sweden. (Fig. 19.7) Finland France Germany Other countries Iceland More recent studies showed five-year survival rates Ireland from ovarian cancer in Northern Ireland to be Italy significantly higher than survival in Canada. Survival Malta in USA, Australia and New Zealand was similar to Netherlands that in Northern Ireland. (Tab. 19.6) Norway European country Poland Portugal Table 19.6: Five-year relative survival from Slovenia ovarian cancer for various countries Spain Period of Country Sweden diagnosis Switzerland Northern Ireland 1997-2000 43.0% UK_England USA 1996-2002 44.7% UK_Scotland Canada 1995-1997 38.0% UK_Wales Australia 1992-1997 42.0% Europe New Zealand 1994-1999 46.3% 0% 10% 20% 30% 40% 50%
Five-year relative survival (%)
Source:EUROCARE-4 (2007)29 19.6: Summary and Discussion Ovarian cancer is one of the most common female cancers, the rates of which are gradually increasing in Northern Ireland. Survival from the disease is average at about 43% after five-years. This however varies considerably depending upon age and stage at diagnosis.
Northern Ireland Cancer Registry 91
Survival of cancer patients in Northern Ireland: 1993-2004
Ovulatory history influences the risk of developing ovarian cancer, with the risk decreasing with the number of pregnancies and being lower among those breast-feeding children84. Being infertile or undergoing fertility treatment can increase the risk of developing ovarian cancer although having a hysterectomy, tubal ligation or using the contraceptive pill can lower the risk84,85,86. Females who have had an early first period or late menopause have a slightly elevated risk of developing cancer of the ovary84.
About 1 in 20 ovarian cancers have a link to family history due to genetic factors associated with the BRCA1 gene, which can be screened for84,87.
92
Prostate cancer
20: PROSTATE CANCER (C61) KEY FACTS: • 656 cases each year during 2000-2004 with an annual increase in incidence rates of 7.6% during 1999-2004; • 215 deaths from the disease each year between 2000 and 2004 with no change in rates during 1993-2004; • Survival was average with 64.5% of males diagnosed in 1997-2000 alive after five years with survival having improved by 8.9% compared to those diagnosed in 1993-1996; • One-year survival was better for 15-64 year olds than for 65-99 year olds; Five-year survival improved for 65-99 year olds between 1993-1996 and 1997-2000; • No difference in survival by deprivation quintile or between urban and rural areas; • Survival estimates using period analysis suggest that five-year survival will increase for males diagnosed in 2001- 2004; • Survival lower than in the rest of UK and Ireland, Europe, USA, Australia, Canada and New Zealand.
20.1: Incidence and Mortality Incidence Between 2000 and 2004 there were on average 656 cases of prostate cancer diagnosed each year. It was the second most common male cancer (after non-melanoma skin cancer) with 14.5% of all cancer cases diagnosed being prostate cancer. (Tab. 20.1) Table 20.1: Incidence and mortality: Prostate cancer (2000- 2004) Mortality Incidence Mortality Prostate cancer was the third most common Number of cases/deaths per year 656 215 Percentage of all cancers 14.5% 11.4% male death representing 11.4% of all male Rank 2 3 cancer deaths with an average of 215 deaths Median age at diagnosis/death 71 79 per year. (Tab. 20.1) Incidence to mortality ratio 3.1:1 - Crude rate per 100,000 persons 79.1 25.9 Trends European age-standardised rate 79.4 25.5 per 100,000 persons (95% CI) (76.7,82.1) (24.0,27.1) During 1993-1999 there was no significant change in incidence rates (EASIR) for prostate cancer (p<0.05) with the number of new cases increasing by 2.4 each year. However between 1999 and 2004 EASIRs increased annually by 7.6% (p=0.001), representing an annual increase of 54.3 cases. (Fig. 20.1; App. 4&6)
Mortality rates (EASMR) remained static during 1993-2004 with no significant trend during the twelve-year period (p>0.05). However, the actual number of deaths increased by an average of 1.9 each year. (Fig. 20.1; App. 5&6)
Geographic variation There was no significant relationship between deprivation, as defined by the 2005 Noble economic deprivation measure7, and incidence or mortality from prostate cancer during 1993-2004. This differs from
Figure 20.1: Incidence and mortality trends: Prostate cancer (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
100 100
90 90
80 80
70 70
60 60
50 50 persons persons 40 40
30 30
20 20
10 10 Age standardised mortality rateper 100,000 Age standardised incidence rate per 100,000 per 100,000 rate incidence standardised Age
0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
Northern Ireland Cancer Registry 93
Survival of cancer patients in Northern Ireland: 1993-2004 previous studies2 based on the 2001 Noble economic deprivation measure which showed higher levels of prostate cancer in the most affluent areas. (Fig. 20.2)
Incidence of prostate cancer were higher in Derry Urban Area and small villages and open countryside during 1993-2004 while lower levels were present in Belfast Metropolitan Area. There was no significant relationship between urban/rural factors and mortality from the disease. (Fig. 20.2)
Figure 20.2: Standardised incidence and mortality ratios for prostate cancer by settlement and deprivation category: 1993-2004 (a) Settlement band (b) Deprivation quintile
Small village, hamlet, open countryside Least Deprived
Village
Intermediate Quintile 4 settlement
Small town
Quintile 3
Medium town Settlement Band Settlement
Large town Quintile Deprivation Quintile 2
Derry Urban Area
Most Deprived Incidence Belfast Metropolitan Incidence Mortality Urban Area Mortality
30 50 70 90 110 130 150 170 70 80 90 100 110 120 130 Lower Standardised Ratio Higher Lower Standardised Ratio Higher
Cases of prostate cancer were higher than expected in Banbridge, Derry, Fermanagh, Moyle, Omagh and Strabane District Councils than in Northern Ireland as a whole in 1993-2004. Lower incidence rates were found in Ards, Belfast and Newtownabbey. Higher mortality rates were present in Fermanagh and Derry while lower than expected mortality rates were present in Belfast, Craigavon and North Down. (Tab. 20.2)
Table 20.2: Standardised incidence and mortality ratios for prostate cancer by District Council: 1993-2004 Local Standardised Standardised Local Standardised Standardised Government Incidence Ratio Mortality Ratio Government Incidence Ratio Mortality Ratio District (95% CI) (95% CI) District (95% CI) (95% CI) Antrim 93.7 (78.8, 108.7) 101.9 (76.1, 127.7) Down 112.1 (98.8, 125.3) 108.4 (87.3, 129.4) Ards 83.8 (73.6, 94.0) 90.4 (73.2, 107.6) Dungannon 99.7 (85.1, 114.3) 85.0 (62.9, 107.1) Armagh 111.9 (97.4, 126.4) 92.2 (70.8, 113.7) Fermanagh 119.2 (105.8, 132.5) 122.3 (100.8, 143.8) Ballymena 101.4 (89.0, 113.8) 106.7 (86.1, 127.3) Larne 86.2 (70.5, 101.9) 104.6 (76.2, 133.1) Ballymoney 86.9 (69.4, 104.4) 106.2 (74.8, 137.6) Limavady 118.6 (97.4, 139.8) 130.3 (93.8, 166.8) Banbridge 120.1 (102.9, 137.3) 101.0 (75.4, 126.5) Lisburn 105.2 (94.8, 115.6) 114.2 (96.3, 132.1) Belfast 83.4 (78.2, 88.7) 89.8 (81.1, 98.5) Magherafelt 91.6 (76.0, 107.2) 81.0 (57.3, 104.7) Carrickfergus 98.1 (81.8, 114.4) 130.7 (99.6, 161.7) Moyle 131.0 (104.3, 157.6) 134.1 (90.9, 177.4) Castlereagh 93.5 (82.8, 104.2) 89.2 (72.3, 106.2) Newry & Mourne 98.1 (86.9, 109.3) 91.8 (74.0, 109.7) Coleraine 109.9 (96.4, 123.3) 118.4 (95.8, 141.1) Newtownabbey 85.5 (75.4, 95.6) 106.2 (87.3, 125.0) Cookstown 101.9 (84.0, 119.9) 110.9 (80.8, 141.1) North Down 91.1 (81.3, 101.0) 82.2 (67.4, 96.9) Craigavon 107.5 (95.6, 119.3) 81.5 (64.5, 98.5) Omagh 130.1 (113.3, 146.9) 101.4 (77.6, 125.1) Derry 127.4 (114.6, 140.3) 128.3 (106.6, 150.1) Strabane 120.8 (102.5, 139.1) 86.9 (61.5, 112.3) SIRs/SMRs in blue represent significantly lower or higher incidence or mortality than in Northern Ireland as a whole.
20.2: Relative Survival One-year relative survival from prostate cancer was 92.8% for patients diagnosed in 2001-2003 while five- year relative survival was 64.5% for patients diagnosed in 1997-2000. (Tab. 20.3)
94
Prostate cancer
Changes over time Table 20.3: Relative survival from prostate cancer by period of diagnosis (1993-2003) There was a significant RELATIVE SURVIVAL (95% CI) improvement in relative survival for Survival time and PATIENTS SURVIVING period of diagnosis ALL PATIENTS males diagnosed with prostate AT LEAST ONE YEAR cancer during 1993-2003 with one- 1993-1996 83.0% (81.0%, 85.1%) year relative survival increasing 1-year* 1997-2000 85.1% (83.2%, 87.0%) from 83.0% for males diagnosed in 2001-2003 92.8% (91.2%, 94.3%) 1993-1996 to 92.8% for males diagnosed in 2001-2003 (p<0.001). 1993-1996 65.9% (63.0%, 68.7%) 78.4% (75.6%, 81.1%) 3-year* Five-year relative survival also 1997-2000 72.3% (69.7%, 74.9%) 84.3% (81.9%, 86.7%) increased between 1993-1996 and 1993-1996 55.6% (52.4%, 58.8%) 65.3% (61.9%, 68.7%) 1997-2000 with an additional 8.9% 5-year* of males surviving five-years from 1997-2000 64.5% (61.4%, 67.6%) 74.4% (71.3%, 77.6%) diagnosis (p=0.006). (Tab. 20.3; 7-year* 1993-1996 50.0% (46.4%, 53.5%) 58.1% (54.2%, 62.0%) Fig. 20.3) * from diagnosis
Conditional survival Five-year relative survival for prostate cancer patients who survived one-year from diagnosis and were diagnosed in 1997-2000 was 74.4% while seven-year survival for those diagnosed in 1993-1996 was 58.1%. This conditional survival rate improved over time with a 9.1% increase in five-year survival from 1993-1996 to 1997-2000 (p=0.006). (Tab. 20.3; Fig. 20.4)
Figure 20.3: Relative survival from prostate cancer by Figure 20.4: Relative survival from prostate cancer by period of diagnosis (1993-2000) period of diagnosis and whether or not patients survive at least one year (1993-2000) 100% 100%
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40% Relative survival (%) Relative survival (%) 30% 30%
20% 20% All (93-96) Survived one-year (93-96) 10% 1993-1996 10% All (97-00) 1997-2000 Survived one-year (97-00) 0% 0% 00 01 02 03 04 05 00 01 02 03 04 05 Time since diagnosis (years) Time since diagnosis (years)
Age One-year relative survival from Table 20.4: Relative survival from prostate cancer by age and period of prostate cancer was higher for those diagnosis (1993-2003) aged 15-64 than 65-99 during 1993- Survival time and RELATIVE SURVIVAL (95% CI) 2003. In particular one-year relative period of diagnosis Aged 15-64 Aged 65-99 survival for those aged 85+ was 1993-1996 89.7% (85.7%, 93.7%) 81.9% (79.7%, 84.2%) significantly lower than other age 1-year 1997-2000 95.0% (92.4%, 97.6%) 83.0% (80.8%, 85.2%) groups. Differences in five-year 2001-2003 98.7% (97.2%, 100.1%) 91.0% (89.0%, 92.9%) relative survival were not statistically 1993-1996 60.7% (54.0%, 67.4%) 54.8% (51.1%, 58.4%) significant. (Tab. 20.4; Fig. 20.5) 5-year 1997-2000 72.0% (66.4%, 77.5%) 63.0% (59.4%, 66.5%)
Five-year relative survival for 65-99 year olds increased during the two periods by 8.2% (p=0.025), which was driven primarily by increases in the 65-74 age group (p=0.018). Improvements in one-year relative survival were also apparent in the 55-64, 65-74 and 75-84 age groups. (Tab. 20.4; Fig. 20.5)
Northern Ireland Cancer Registry 95
Survival of cancer patients in Northern Ireland: 1993-2004
Figure 20.5: Relative survival from prostate cancer by age and period of diagnosis (1993-2003) (a) One-year (b) Five-year
100% 1993-1996 1997-2000 2001-2003 100% 1993-1996 1997-2000
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40%
Relative survival (%) 30% Relative survival (%) 30%
20% 20%
10% 10%
0% 0% 15-54 55-64 65-74 75-84 85+ 15-54 55-64 65-74 75-84 85+ Age Age
Deprivation and urban/rural factors Relative survival from prostate cancer during 1993-2000 did not vary significantly by level of deprivation with five-year relative survival for patients who resided in the 20% most affluent areas in Northern Ireland being 61.0% compared to 58.4% for those who resided in the 20% most deprived areas in Northern Ireland (p>0.05). (Fig. 20.6)
The majority of variations in one and five-year relative survival from prostate cancer between different settlement types were not statistically significant. However five-year relative survival in Derry Urban Area was significantly higher than in Belfast Metropolitan Area (p=0.018). (Fig. 20.6)
Figure 20.6: Relative survival from prostate cancer by deprivation quintile and settlement band (1993-2000) (a) Deprivation quintile (b) Settlement band
Belfast Metropolitan Area Most deprived
Derry Urban Area
Quintile 2 Large town
Medium town Quintile 3 Small town Settlement band Settlement Deprivation quintile Deprivation Quintile 4 Intermediate settlement
Village
Least deprived Small village, hamlet and open countryside 1-year 1-year 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 5-year Relative survival (%) 5-year Relative survival (%)
20.3: Observed Survival Table 20.5: Observed survival from prostate cancer by One-year observed survival (which takes into sex and period of diagnosis (1993-2003) Survival time and account deaths from all causes and therefore is OBSERVED SURVIVAL (95% CI) lower than relative survival) was 88.5% for patients period of diagnosis diagnosed with prostate cancer in 2001-2003. Five- 1993-1996 77.5% (75.6%, 79.5%) year observed survival was 47.1% for patients 1-year 1997-2000 80.0% (78.2%, 81.8%) 2001-2003 88.5% (87.0%, 89.9%) diagnosed in 1997-2000. (Tab. 20.5)
1993-1996 38.6% (36.4%, 40.8%) 5-year 1997-2000 47.1% (44.8%, 49.3%)
96
Prostate cancer
20.4: Period Analysis Figure 20.7: Estimated relative survival (period analysis) from prostate cancer for patients diagnosed in 2001-2004 compared with actual Five-year relative survival from relative survival (cohort analysis) for patients diagnosed in 1997-2000. prostate cancer for patients diagnosed 100% in 2001-2004 cannot be derived using traditional methods (cohort analysis) 90% but can be estimated using newer 80% techniques such as period analysis. 70% Using this method five-year relative survival from prostate cancer for 60% males diagnosed in 2001-2004 was 50% 72.2%. While not directly comparable to the cohort analysis this would 40% Relative survival (%) survival Relative constitute a significant improvement of 30%
7.7% compared to the five-year 20% relative survival for patients diagnosed 1997-2000 (Cohort analysis) in 1997-2000 (p>0.05). (Fig.20.7; 10% 2001-2004 (Period analysis) App.7) 0% 00 01 02 03 04 05 Time since diagnosis (years)
20.5: International Comparisons EUROCARE-4 study Based upon age-standardised five-year relative Figure 20.8: Comparison of five-year age-standardised survival estimates, for patients diagnosed in 1995- relative survival from prostate cancer with other European countries 1999 with prostate cancer, relative survival in Europe was higher than that in Northern Ireland by Northern Ireland 14.9%. The biggest differences (more than 20%) Austria between Northern Ireland and individual European Belgium Czech countries were with Austria, Belgium, Germany, Denmark Portugal and Switzerland. Survival was also lower Finland than that in the rest of the UK and Ireland by France between 7-11%. Survival in Northern Ireland from Germany this disease was higher than in Denmark and Iceland similar to Slovenia and Poland. (Fig. 20.8) Ireland Italy Malta Other countries Netherlands For patients diagnosed with prostate cancer during Norway the late 1990s survival in Northern Ireland was country European Poland significantly (p<0.05) lower than in USA, Canada, Portugal Slovenia New Zealand and Australia. (Tab. 20.6) Spain Sweden Table 20.6: Five-year relative survival from Switzerland prostate cancer for various countries UK_England Period of Country UK_Scotland diagnosis UK_Wales Northern Ireland 1997-2000 64.5% EUROPE USA 1996-2002 99.9% 0% 20% 40% 60% 80% 100% Canada 1995-1997 91.0% Five-year relative survival (%) Australia 1992-1997 82.7% 29 New Zealand 1994-1999 85.5% Source:EUROCARE-4 (2007)
20.6: Summary and Discussion Family history is a strong risk factor in the development of prostate cancer, with the risk for males with a relative diagnosed with the disease being twice that of an average male. This risk increases to three times the average if the relative is a brother and increases to four times the average if a father, brother or son
Northern Ireland Cancer Registry 97
Survival of cancer patients in Northern Ireland: 1993-2004 was diagnosed before age 6088. A strong family history of breast cancer is also an indication of an increased risk as it may indicate the presence of the faulty BRCA1 gene which can cause prostate cancer in men88. Other known, but relatively weak risk factors for prostate cancer are black ethnic race88, radiation exposure88 and a diet with high animal fat consumption89 and low levels of selenium88.
Levels of prostate cancer in Northern Ireland have increased considerably since 1999 due to the increase in the use of PSA testing. Mortality rates have however remained static during the last twelve years while five-year survival rates have increased. The later is a result of the introduction of PSA testing with diagnosis being made at a point much closer to when the cancer first developed. This has the effect of increasing survival time from the date of diagnosis to death; however the actual time from the development of cancer to death may not have changed. The variation in the use of PSA testing throughout different countries may partially explain the considerable variation in survival rates throughout the world. For example PSA testing has been widespread in other parts of the UK and Europe for a longer period of time than in Northern Ireland. As a result a higher proportion of prostate cancers were detected at an earlier stage in these countries. Given that early cancers have a much better prognosis, overall survival for patients in these areas, diagnosed during the late 1990s, was higher than in Northern Ireland.
98
Testicular cancer
21: TESTICULAR CANCER (C62) KEY FACTS: • 60 newly diagnosed cases per year between 2000 and 2004 with no significant change in incidence rates between 1993 and 2004; • Less than 5 deaths from the disease each year between 2000 and 2004 with no significant change in mortality rates between 1993 and 2004; • Survival excellent with 96.0% of males alive after five years, but no significant change in survival between 1993- 1996 and 1997-2000; • Similar survival to England, Europe, USA, Canada, New Zealand and Australia.
21.1: Incidence and Mortality Incidence Between 2000 and 2004 there was an average of 60 males diagnosed each year with testicular cancer representing 1.3% of all newly diagnosed male cancers making it the fifteenth most common male cancer. The median age at diagnosis for this cancer Table 21.1: Incidence and mortality: Testicular cancer (2000- was 35, which was younger than for any other 2004) cancer. (Tab. 21.1) Incidence Mortality Number of cases/deaths per year 60 <5 Mortality Percentage of all cancers 1.3% - Rank 15 22 Testicular cancer was the twenty-second Median age at diagnosis/death 35 28 most common cause of male cancer death Crude rate per 100,000 persons 7.2 - with less than five male deaths occurring European age-standardised rate 7.2 - annually from 2000 to 2004 as a result of the per 100,000 persons (95% CI) (6.3,8.0) - disease. (Tab. 21.1)
Trends Incidence rates (EASIR) varied considerably during 1993-2004, with no significant trend during the twelve- year period (p=0.083) although the number of cases increased annually by an average of 1.4. (Fig. 21.1; App. 4&6)
No significant trend existed for mortality rates (EASMR) between 1993 and 2004 (p>0.05), with the annual change in the number of deaths remaining static over time. (Fig. 21.1; App. 5&6)
Figure 21.1: Incidence and mortality trends: Testicular cancer (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
12 12
10 10
8 8
6 6 persons persons
4 4
2 2 Age standardised mortality rate per 100,000 100,000 per rate mortality standardised Age Age standardised incidence rate per 100,000 100,000 per rate incidence standardised Age
0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
21.2: Relative Survival Relative survival from testicular cancer was excellent with 95.9% of patients diagnosed between 2001 and 2003 surviving one year and 96.0% of patients diagnosed between 1997 and 2000 surviving five years. (Tab. 21.2)
Northern Ireland Cancer Registry 99
Survival of cancer patients in Northern Ireland: 1993-2004
Changes over time There was no statistically significant change in either one or five-year relative survival for patients diagnosed with testicular cancer between 1993 and 2003. (Tab. 21.2; Fig. 21.2)
Table 21.2: Relative survival from testicular Figure 21.2: Relative survival from testicular cancer by period of cancer by period of diagnosis (1993-2003) diagnosis (1993-2000)
Survival time and RELATIVE SURVIVAL 100% period of diagnosis (95% CI) 90%
1993-1996 96.1% (93.3%, 98.9%) 80% 1-year 1997-2000 99.0% (97.4%, 100.5%) 70% 2001-2003 95.9% (92.8%, 99.0%) 60% 1993-1996 92.9% (89.1%, 96.7%) 3-year 50% 1997-2000 97.8% (95.4%, 100.1%) 40%
1993-1996 92.4% (88.3%, 96.4%) Relative survival (%) 5-year 30% 1997-2000 96.0% (92.8%, 99.2%) 20%
10% 1993-1996 1997-2000 0% 00 01 02 03 04 05 Time since diagnosis (years) 21.3: International Comparisons EUROCARE-3 study For males diagnosed with testicular cancer between Figure 21.3: Comparison of five-year age-standardised 1993 and 1996 the five-year age-standardised relative survival from testicular cancer with other European countries relative survival rate was 91.2%. This was equivalent to testicular cancer survival in the Northern Ireland majority of European countries included in the Austria EUROCARE3 study. The exception was Estonia Czech Republic Denmark and Poland, which had significantly lower relative England survival compared to Northern Ireland (Fig. 21.3). Estonia Finland Other countries France Germany Five-year relative survival rates from testicular Iceland cancer in Northern Ireland were similar to those in Italy Australia, New Zealand, Canada and USA with no Malta more than a 1.0% difference existing between Netherlands Northern Ireland and these countries. (Tab. 21.3) Norway
country European Poland Table 21.3: Five-year relative survival from Portugal testicular cancer for various countries Scotland Slovakia Period of Country Slovenia diagnosis Spain Northern Ireland 1997-2000 96.0% Sweden USA 1996-2002 95.7% Switzerland Canada 1995-1997 95.0% Wales Australia 1992-1997 95.4% EUROPE New Zealand 1994-1999 95.4% 0% 20% 40% 60% 80% 100% Five-year relative survival (%) Source: EUROCARE-3 (2003) 27,28 21.4: Summary and Discussion Testicular cancer is a relatively rare disease occurring mainly in males aged between 25 and 45. While not substantiated in Northern Ireland due to the small number of cases, rates of new cases of the disease are increasing in many countries, including England and Wales31 for as yet unknown reasons. The number of
100
Testicular cancer deaths due to the disease is however small and mortality rates in England and Wales are declining as survival improves31. Survival in Northern Ireland along with most European and North American countries is high being typically above 95% after five years.
Most cases of testicular cancer have no detectable risk factor. However a history of undescended testes can increase risk by up to ten times90. The use of an operation to lower the testes reduces this risk, but the risk of developing cancer of the testes is still higher than average90. Infertility and fertility problems can increase risk90 as can the inheritance of a faulty gene, TGCT1, which can increase risk up to five times and can result in family clusters of testicular cancer90. The probability of developing testicular cancer due to infertility problems or genetic factors remains small.
Northern Ireland Cancer Registry 101
Survival of cancer patients in Northern Ireland: 1993-2004
22: CANCER OF THE KIDNEY (C64-C66, C68) KEY FACTS: • 110 male and 71 female cases per year between 2000 and 2004 with no significant change in male or female incidence rates between 1993 and 2004; • 55 male and 32 female deaths per year between 2000 and 2004 with male mortality rates increasing by 2.5% per year between 1993 and 2004 with no significant change in female mortality rates; • Survival similar in males and females with 53.0% of males and 50.3% of females alive after five years, but no significant change in survival between 1993-1996 and 1997-2000; • Survival better for those aged 15-64 than for those aged 65 and over; • Survival better than in Wales and Scotland, similar to Europe but worse than in USA, Canada and Australia.
22.1: Incidence and Mortality Incidence Between 2000 and 2004 there were 110 male and 71 female cases of cancer of the kidney diagnosed each year. It represented 2.4% of all male and 1.6% of all female cancer cases. It was the eighth most common male cancer and the twelfth Table 22.1: Incidence and mortality: Cancer of the kidney (2000-2004) most common female cancer. (Tab. 22.1) Incidence Mortality Male Female Male Female
Number of cases/deaths per year 110 71 55 32 Mortality Percentage of all cancers 2.4% 1.6% 2.9% 1.8% There were 55 male deaths from Rank 8 12 9 12 Median age at diagnosis/death 67 69 71 76 cancer of the kidney each year Male to female ratio 1.5:1 - 1.7:1 - between 2000 and 2004, 2.9% Incidence to mortality ratio 2.0:1 2.2:1 - - of male cancer deaths. Among Crude rate per 100,000 persons 13.2 8.2 6.6 3.7 females there were 32 deaths European age-standardised rate 13.5 7.1 6.7 2.7 per year from cancer of the per 100,000 persons (95% CI) (12.4,14.6) (6.3,7.8) (5.9,7.6) (2.3,3.2) kidney during this period, 1.8% of female cancer deaths. It was the ninth and twelfth commonest form of male and female cancer death respectively. (Tab. 22.1)
Trends Incidence rates (EASIR) for kidney cancer among males and females were static during 1993-2004 with no significant trend present (p>0.05). However due to the ageing of the population, the number of cases of cancer of the kidney increased annually by 1.5 male and 1.2 female cases. (Fig. 22.1; App. 4&6)
Male mortality rates (EASMR) for kidney cancer increased during 1993-2004 by 2.5% each year (p= 0.030) while no significant trend in female EASMRs existed during this period. The number of deaths as a result of this disease rose annually by 1.9 male and 1.1 female deaths. (Fig. 22.1; App. 5&6)
Figure 22.1: Incidence and mortality trends: Cancer of the kidney (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
20 20 Male Female Male Female 18 18
16 16
14 14
12 12
10 10 persons persons 8 8
6 6
4 4
2 rate per 100,000 Age standardised mortality 2 Age standardised incidence rate per 100,000 100,000 incidence rate per Age standardised
0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
102
Cancer of the kidney
22.2: Relative Survival One-year relative survival from cancer of the kidney was 63.6% for patients diagnosed in 2001-2003 while five-year relative survival was 51.9% for patients diagnosed in 1997-2000. (Tab. 22.2)
Table 22.2: Relative survival from cancer of the kidney by sex and period of diagnosis (1993-2003) Survival time and RELATIVE SURVIVAL (95% CI) period of diagnosis Males Females All persons ALL PATIENTS 1993-1996 66.8% (61.6%, 72.0%) 68.7% (62.2%, 75.1%) 67.5% (63.5%, 71.6%) 1-year 1997-2000 67.2% (61.9%, 72.4%) 64.4% (58.3%, 70.5%) 66.0% (62.0%, 70.0%) 2001-2003 62.7% (57.0%, 68.4%) 65.2% (57.8%, 72.6%) 63.6% (59.1%, 68.1%)
1993-1996 56.5% (50.6%, 62.4%) 56.0% (48.8%, 63.2%) 56.3% (51.7%, 60.9%) 3-year 1997-2000 55.5% (49.6%, 61.5%) 55.4% (48.7%, 62.1%) 55.5% (51.1%, 59.9%)
1993-1996 50.1% (43.7%, 56.4%) 51.1% (43.5%, 58.8%) 50.5% (45.6%, 55.4%) 5-year 1997-2000 53.0% (46.7%, 59.4%) 50.3% (43.2%, 57.4%) 51.9% (47.1%, 56.6%)
7-year 1993-1996 47.4% (40.7%, 54.0%) 46.5% (38.5%, 54.5%) 47.0% (41.9%, 52.1%)
PATIENTS SURVIVING AT LEAST ONE YEAR (ONE-YEAR CONDITIONAL SURVIVAL) 1993-1996 84.1% (78.3%, 89.9%) 81.2% (74.0%, 88.3%) 82.9% (78.4%, 87.5%) 3-year* 1997-2000 82.3% (76.3%, 88.3%) 85.7% (79.3%, 92.0%) 83.7% (79.3%, 88.1%)
1993-1996 74.1% (66.7%, 81.4%) 73.7% (65.1%, 82.3%) 73.9% (68.4%, 79.5%) 5-year* 1997-2000 78.2% (71.0%, 85.3%) 77.3% (69.2%, 85.3%) 77.8% (72.5%, 83.1%)
7-year* 1993-1996 69.7% (61.6%, 77.9%) 66.5% (56.9%, 76.1%) 68.4% (62.2%, 74.6%) * from diagnosis
Sex There were no statistically significant differences in relative survival for males and females (p>0.05) diagnosed with kidney cancer during 1993-2003. For example five-year relative survival for males diagnosed in 1997-2000 was 53.0% compared to 50.3% for females (p>0.05). (Tab. 22.2; Fig.22.2)
Changes over time There were no statistically significant changes in male or female one, three or five-year relative survival for patients diagnosed with cancer of the kidney during 1993-2003 (p>0.05). (Tab.22.2; Fig. 22.2)
Figure 22.2: Relative survival from cancer of the kidney Figure 22.3: Relative survival from cancer of the kidney by sex and period of diagnosis (1993-2000) by period of diagnosis and whether or not patients survive at least one year (1993-2000) 100% 100%
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40%
Relative survival (%) 30% Relative survival (%) 30%
20% Male (93-96) 20% All (93-96) Female (93-96) Survived one-year (93-96) 10% Male (97-00) 10% All (97-00) Female (97-00) Survived one-year (97-00) 0% 0% 00 01 02 03 04 05 00 01 02 03 04 05 Time since diagnosis (years) Time since diagnosis (years)
Northern Ireland Cancer Registry 103
Survival of cancer patients in Northern Ireland: 1993-2004
Conditional survival Five-year relative survival for patients who survived one year from diagnosis and were diagnosed in 1997- 2000 was 77.8% while seven-year survival was 68.4% for those diagnosed in 1993-1996. This conditional survival rate did not vary by sex during 1993-2003 and there were no significant changes over time (p>0.05). (Tab. 22.2; Fig. 22.3)
Age For patients diagnosed in 1997- Table 22.3: Relative survival from cancer of the kidney by age and period of 2000 five-year relative survival for diagnosis (1993-2003) those aged 15-64 was 63.0%, Survival time and RELATIVE SURVIVAL (95% CI) which was higher than the 44.3% period of diagnosis Aged 15-64 Aged 65-99 of those aged 65-99 who survived 1993-1996 74.0% (68.3%, 79.7%) 62.9% (57.3%, 68.5%) five-years (p=0.004). In particular 1-year 1997-2000 77.3% (71.8%, 82.7%) 58.6% (53.2%, 64.0%) five-year relative survival for 2001-2003 71.8% (65.4%, 78.1%) 57.7% (51.5%, 63.9%) females aged either 65-74 or 75-99 1993-1996 55.6% (48.9%, 62.3%) 46.8% (39.9%, 53.8%) and diagnosed in 1997-2000 was 5-year 1997-2000 63.0% (56.4%, 69.5%) 44.3% (37.7%, 50.8%) significantly worse than for those aged 15-44 (p=0.022; p=0.003). (Tab. 22.3; Fig. 22.4)
There were no statistically significant changes over time for 15-64 or 65-99 age groups or for individual male or female age groups (p>0.05). (Tab. 22.3; Fig. 22.4)
Figure 22.4: Relative survival from cancer of the kidney by age, sex and period of diagnosis (1993-2003) (a) One-year (b) Five-year
100% 1993-1996 1997-2000 2001-2003 100% 1993-1996 1997-2000
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40% Relative survival (%) survival Relative
Relative survival (%) 30% 30%
20% 20%
10% 10%
0% 0% Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female 15-44 45-54 55-64 65-74 75+ 15-44 45-54 55-64 65-74 75+ Sex and Age Sex and Age
22.3: Observed Survival Observed survival from cancer of the kidney, which takes into account deaths from all causes, was moderate with 60.7% of male and 63.5% of female patients diagnosed in 2001-2003 alive after one-year. Five-year observed survival was 44.1% for male and 43.9% for female patients diagnosed in 1997-2000. (Tab. 22.4)
Table 22.4: Observed survival from cancer of the kidney by sex and period of diagnosis (1993-2003) Survival time and OBSERVED SURVIVAL (95% CI) period of diagnosis Males Females All persons 1993-1996 64.3% (59.3%, 69.4%) 66.8% (60.6%, 73.1%) 65.3% (61.4%, 69.2%) 1-year 1997-2000 64.7% (59.6%, 69.8%) 62.7% (56.7%, 68.7%) 63.9% (60.0%, 67.7%) 2001-2003 60.7% (55.1%, 66.2%) 63.5% (56.3%, 70.8%) 61.7% (57.3%, 66.1%)
1993-1996 41.2% (36.0%, 46.4%) 44.2% (37.6%, 50.8%) 42.3% (38.3%, 46.4%) 5-year 1997-2000 44.1% (38.8%, 49.4%) 43.9% (37.7%, 50.1%) 44.0% (40.0%, 48.1%)
104
Cancer of the kidney
22.4: Period Analysis Figure 22.5: Estimated relative survival (period analysis) from cancer of the kidney for patients diagnosed in 2001-2004 compared with actual Five-year relative survival for the relative survival (cohort analysis) for patients diagnosed in 1997-2000. 2001-2004 period cannot be 100% calculated using traditional methods (cohort analysis) as five-years worth 90% of follow up are required. Period 80% analysis which examines the more 70% recent experience of patients can provide more up to date estimates. 60%
Five-year relative survival from cancer 50% of the kidney for males diagnosed in 2001-2004 derived using this 40% Relative survival (%) survival Relative approach was 48.9% while for 30% females it was 55.1%. This does not 20% Male (97-00: Cohort analysis) represent a significant difference Female (97-00: Cohort analysis) 10% between the two sexes (p>0.05). (Fig. Male (01-04: Period analysis) Female (01-04: Period analysis) 22.5; App. 7) 0% 00 01 02 03 04 05 Time since diagnosis (years) While not directly comparable these estimates do not constitute a significant difference from the actual five-year relative survival derived using cohort analysis for patients diagnosed in 1997-2000 (p>0.05). (Fig. 22.5; App. 7)
22.5: International Comparisons EUROCARE-3 study Age-standardised five-year relative survival from cancer of the kidney in Europe was 54.2% for males and 57.2% for females, which was higher than the 49.2% for males and 51.1% for females in Northern Ireland.
Figure 22.6: Comparison of five-year age-standardised relative survival from cancer of the kidney with other European countries (a) Male (b) Female
Northern Ireland Northern Ireland Austria Austria Czech Republic Czech Republic Denmark Denmark England England Estonia Estonia Finland Finland France France Germany Germany Iceland Iceland Italy Italy Malta Malta Netherlands Netherlands Norway Norway European country European country European Poland Poland Portugal Portugal Scotland Scotland Slovakia Slovakia Slovenia Slovenia Spain Spain Sweden Sweden Switzerland Switzerland Wales Wales EUROPE EUROPE
0% 10% 20% 30% 40% 50% 60% 70% 80% 0% 10% 20% 30% 40% 50% 60% 70% 80% Five-year relative survival (%) Five-year relative survival (%)
Source: EUROCARE-3 (2003) 27,28
Northern Ireland Cancer Registry 105
Survival of cancer patients in Northern Ireland: 1993-2004
While this difference was not statistically significant the survival in Austria and France was significantly better for both males and females. It was also significantly better in Italy for males and in Germany for females. Survival in Northern Ireland was better than in Scotland and Wales and than in England for females. (Fig. 22.6)
Table 22.5: Five-year relative survival from cancer of Other countries the kidney for various countries Period of Comparisons between Northern Ireland and other Country Male Female diagnosis countries illustrate that survival was lower in Northern Northern Ireland 1997-2000 53.0% 50.3% Ireland than in USA, Canada and Australia. (Tab. USA 1996-2002 65.7% 65.4% 22.5) Canada 1995-1997 64.0% 66.0% Australia 1992-1997 59.9% 57.5% New Zealand 1994-1999 57.1% 55.8% 22.6: Summary and Discussion The risk of developing cancer of the kidney is approximately 1 in 90 for males and 1 in 170 for females. It can depend greatly on lifestyle factors, with tobacco use and obesity91,92 being significant risk factors with smokers being twice as likely as non-smokers to develop the disease91. Eating a well balanced diet is thought to lower the risk of developing this cancer type91.
High blood pressure and kidney failure resulting in the use of regular dialysis increases the risk of developing cancer of the kidney91. Some inherited diseases or conditions also increase kidney cancer risk (Von Hippel-Lindau (VHL) syndrome, tuberous sclerosis, Birt-Hogg-Dube syndrome, hereditary non-VHL clear cell renal cell cancer and hereditary papillary renal cell cancer) while some kidney cancers (familial kidney cancer) can be caused by inheriting faulty genes91. Chemicals and compounds such as asbestos, cadmium, trichloroethylene and dry cleaning solutions can increase the risk of developing kidney cancer91. Consequently higher levels of incidence of kidney cancer are linked with those working in the petrochemical and iron and steel industries91. The use of some mild painkillers is also potentially linked to an increased risk of kidney cancer, although work is continuing into the types of painkiller that may induce an increased hazard91.
Levels of kidney cancer in the UK have increased since the mid 1970s; however as in Northern Ireland, incidences of this cancer have remained fairly static since 199331. Survival is moderate at 50% of persons surviving five years, which is similar to the rest of the UK but worse than some European countries and North America. There has been no improvement in survival from kidney cancer over the last ten years however new treatments currently in the development and testing phase, such as the TroVax vaccine93, have the potential to start improving the survival rate within the next ten years.
106
Cancer of the bladder
23: CANCER OF THE BLADDER (C67) KEY FACTS: • 143 male and 57 female cases per year between 2000 and 2004 with no significant change in male or female incidence rates between 1993 and 2004; • 55 male and 30 female deaths per year between 2000 and 2004 with no significant change in male or female mortality rates between 1993 and 2004; • Survival moderate with 55.1% of patients diagnosed in 1997-2000 surviving five years; • Survival better in males than females: 83.9% of males and 58.2% of females alive after one year, with no significant change in survival between 1993-1996 and 1997-2000; • Survival better for those aged 15-64 than for those aged 65 and over; • Survival poorer than in rest of UK, Europe, USA, Canada, Australia and New Zealand.
23.1: Incidence and Mortality Incidence Cancer of the bladder was the sixth commonest male cancer during 2000-2004 with an average of 143 cases diagnosed each year; 3.2% of male cases. Age-standardised rates for this cancer were 3.5 times greater among males than Table 23.1: Incidence and mortality: Cancer of the bladder (2000-2004) females with 57 females diagnosed annually with the Incidence Mortality Male Female Male Female disease. It made up 1.2% of Number of cases/deaths per year 143 57 55 30 female cancers during 2000- Percentage of all cancers 3.2% 1.2% 2.9% 1.7% 2004 and was the fifteenth most Rank 6 15 8 13 common female cancer. (Tab. Median age at diagnosis/death 72 75 77 79 23.1) Male to female ratio 2.5:1 - 1.9:1 - Incidence to mortality ratio 2.6:1 1.9:1 - - Crude rate per 100,000 persons 17.3 6.5 6.7 3.4 Mortality European age-standardised rate 17.2 4.9 6.7 2.3 There were 55 male and 30 per 100,000 persons (95% CI) (15.9,18.5) (4.3,5.5) (5.9,7.5) (1.9,2.7) female deaths from cancer of the bladder each year during 2000-2004 representing 2.9% and 1.7% of male and female cancer deaths respectively. It was the eighth commonest cause of cancer death among males and thirteenth among females. (Tab. 23.1)
Trends No significant trends in male or female incidence rates (EASIR) existed for cancer of the bladder during 1993-2004 (p>0.05) with little annual change in the number of cases. (Fig. 23.1; App. 4&6)
Male and female mortality rates were also static during 1993-2004 (p>0.05) with an annual decrease in the number of cases of 0.7 and 0.4 for males and females respectively. (Fig. 23.1; App. 5&6)
Figure 23.1: Incidence and mortality trends: Cancer of the bladder (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
30 30 Male Male Female Female
25 25
20 20
15 15 persons persons
10 10
5 5 Age standardised mortality rate per 100,000 rate per Agemortality standardised Age standardised incidence rate per 100,000 Age standardised incidence rate
0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
Northern Ireland Cancer Registry 107
Survival of cancer patients in Northern Ireland: 1993-2004
23.2: Relative Survival Relative survival from cancer of the bladder was moderate with 76.8% of patients diagnosed in 2001-2003 surviving one year and 55.1% of patients diagnosed in 1997-2000 surviving five years. (Tab. 23.2)
Table 23.2: Relative survival from cancer of the bladder by sex and period of diagnosis (1993-2003) Survival time and RELATIVE SURVIVAL (95% CI) period of diagnosis Males Females All persons ALL PATIENTS 1993-1996 77.9% (74.1%, 81.7%) 61.6% (55.1%, 68.2%) 73.1% (69.7%, 76.4%) 1-year 1997-2000 80.6% (76.8%, 84.3%) 59.1% (52.3%, 66.0%) 74.4% (71.0%, 77.8%) 2001-2003 83.9% (79.6%, 88.1%) 58.2% (49.8%, 66.7%) 76.8% (72.8%, 80.8%)
1993-1996 63.0% (58.2%, 67.8%) 46.2% (39.2%, 53.3%) 58.0% (54.0%, 62.0%) 3-year 1997-2000 64.7% (59.8%, 69.6%) 47.6% (40.2%, 55.0%) 59.8% (55.7%, 63.9%)
1993-1996 57.5% (52.1%, 62.9%) 41.5% (34.1%, 49.0%) 52.7% (48.3%, 57.1%) 5-year 1997-2000 58.7% (53.2%, 64.2%) 45.9% (38.0%, 53.9%) 55.1% (50.5%, 59.6%)
7-year 1993-1996 52.0% (46.2%, 57.8%) 38.7% (31.0%, 46.4%) 48.1% (43.4%, 52.7%)
PATIENTS SURVIVING AT LEAST ONE YEAR (ONE-YEAR CONDITIONAL SURVIVAL) 1993-1996 80.2% (75.4%, 84.9%) 74.4% (66.2%, 82.6%) 78.7% (74.6%, 82.8%) 3-year* 1997-2000 79.7% (75.0%, 84.5%) 80.0% (71.7%, 88.3%) 79.8% (75.7%, 83.9%)
1993-1996 72.5% (66.8%, 78.3%) 66.3% (56.8%, 75.8%) 70.9% (66.0%, 75.8%) 5-year* 1997-2000 71.8% (66.0%, 77.6%) 76.6% (66.7%, 86.4%) 72.9% (67.9%, 77.9%)
7-year* 1993-1996 65.2% (58.7%, 71.7%) 61.3% (51.0%, 71.6%) 64.2% (58.7%, 69.7%) * from diagnosis Sex Relative survival from cancer of the bladder among males was better than among females with 83.9% of males diagnosed with this cancer in 2001-2003 surviving one year compared to 58.2% of females (p<0.001). For patients diagnosed in 1993-1996 a statistically significant difference of 16% existed between male and female five-year relative survival (p=0.014). (Tab. 23.2; Fig. 23.2)
Changes over time Changes in male or female relative survival for patients diagnosed with cancer of the bladder between 1993 and 2003 were not statistically significant (p>0.05) with five-year relative survival for patients diagnosed in 1997-2000 being 52.7% compared to 55.1% for those diagnosed in 1993-1996. (Tab. 23.2; Fig. 23.2)
Figure 23.2: Relative survival from cancer of the bladder Figure 23.3: Relative survival from cancer of the bladder by sex and period of diagnosis (1993-2000) by period of diagnosis and whether or not patients survive at least one year (1993-2000) 100% 100%
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40%
Relative survival (%) 30% Relative survival (%) 30%
20% Male (93-96) 20% All (93-96) Female (93-96) Survived one-year (93-96) 10% Male (97-00) 10% All (97-00) Female (97-00) Survived one-year (97-00) 0% 0% 00 01 02 03 04 05 00 01 02 03 04 05 Time since diagnosis (years) Time since diagnosis (years)
108
Cancer of the bladder
Conditional survival For patients diagnosed with cancer of the bladder in 1997-2000 who were alive one-year after diagnosis 72.9% survived five-years from diagnosis, while seven-year survival for patients diagnosed in 1993-1996 who survived at least one-year from diagnosis was 64.2%. Conditional survival for cancer of the bladder did not vary by sex while there were no significant changes over time (p>0.05). (Tab. 23.2; Fig. 23.3)
Age For patients diagnosed in 1997- Table 23.3: Relative survival from cancer of the bladder by age and period 2000 five-year relative survival for of diagnosis (1993-2003) those aged 15-64 was 71.7% which Survival time and RELATIVE SURVIVAL (95% CI) was significantly higher than the period of diagnosis Aged 15-64 Aged 65-99 48.7% of those aged 65-99 1993-1996 82.0% (76.5%, 87.5%) 70.1% (66.0%, 74.1%) (p<0.001). One-year relative survival 1-year 1997-2000 85.6% (80.5%, 90.8%) 70.5% (66.3%, 74.6%) was also better for 15-64 year olds 2001-2003 84.7% (78.1%, 91.4%) 74.4% (69.7%, 79.2%) diagnosed during this period and 1993-1996 70.5% (63.5%, 77.4%) 46.2% (40.9%, 51.5%) during 1993-1996 (p=0.014; 5-year 1997-2000 71.7% (64.8%, 78.7%) 48.7% (43.2%, 54.3%) p=0.001). (Tab. 23.3)
There were no changes in one or five-year relative survival for either 15-64 or 65-99 year olds over time (p>0.05). However the male 65-74 age group demonstrated a significant improvement in one-year relative survival from 80.5% for patients diagnosed in 1997-2000 to 92.9% for patients diagnosed in 2001-2003 (p=0.035). (Tab. 23.3; Fig. 23.4; App. 8)
Figure 23.4: Relative survival from cancer of the bladder by age, sex and period of diagnosis (1993-2003) (a) One-year (b) Five-year
100% 1993-1996 1997-2000 2001-2003 100% 1993-1996 1997-2000
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40% Relative survival (%) 30% Relative survival (%) 30%
20% 20%
10% 10%
0% 0% Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female 15-44 45-54 55-64 65-74 75+ 15-44 45-54 55-64 65-74 75+ Sex and Age Sex and Age Note: Missing entries refer to less than 10 persons in that age/sex group
23.3: Observed Survival One-year observed survival (which takes into account deaths from all causes and therefore is lower than relative survival) from cancer of the bladder was 79.6% for male and 55.9% for female patients diagnosed between 2001 and 2003. Five-year observed survival was 45.4% for male and 37.2% for female patients diagnosed between 1997 and 2000. (Tab. 23.4)
Table 23.4: Observed survival from cancer of the bladder by sex and period of diagnosis (1993-2003) Survival time and OBSERVED SURVIVAL (95% CI) period of diagnosis Males Females All persons 1993-1996 73.8% (70.2%, 77.5%) 59.1% (52.8%, 65.3%) 69.5% (66.3%, 72.7%) 1-year 1997-2000 76.6% (73.0%, 80.2%) 56.6% (50.1%, 63.2%) 70.8% (67.6%, 74.1%) 2001-2003 79.6% (75.6%, 83.7%) 55.9% (47.8%, 63.9%) 73.1% (69.3%, 76.9%)
1993-1996 44.0% (39.8%, 48.1%) 33.8% (27.7%, 39.8%) 40.9% (37.5%, 44.3%) 5-year 1997-2000 45.4% (41.1%, 49.6%) 37.2% (30.8%, 43.6%) 43.0% (39.4%, 46.5%)
Northern Ireland Cancer Registry 109
Survival of cancer patients in Northern Ireland: 1993-2004
23.4: Period Analysis Figure 23.5: Estimated relative survival (period analysis) from cancer of the bladder for patients diagnosed in 2001-2004 compared with actual Five-year survival from cancer of the relative survival (cohort analysis) for patients diagnosed in 1997-2000. bladder for patients diagnosed in 100% 2001-2004 cannot be derived using traditional methods (cohort analysis) 90% but can be estimated using newer 80% techniques (period analysis). Using 70% this method five-year survival from cancer of the bladder for males 60% diagnosed in 2001-2004 was 59.3% 50% while for females it was 47.2%. This did not represent a significant 40% Relative survival (%) survival Relative difference between the two sexes 30%
(p>0.05), although only by a small 20% Male (97-00: Cohort analysis) margin. (Fig. 23.5; App. 7) Female (97-00: Cohort analysis) 10% Male (01-04: Period analysis) Female (01-04: Period analysis) While not directly comparable the 0% 00 01 02 03 04 05 results from the period analysis do not Time since diagnosis (years) constitute a significant difference from the actual five-year relative survival derived using cohort analysis for patients diagnosed in 1997-2000 (p>0.05). (Fig. 23.5; App.7)
23.5: International Comparisons EUROCARE-3 study Comparing the male and female age-standardised relative survival rates for persons in Northern Ireland diagnosed with cancer of the bladder during 1993-1996 with the results from the EUROCARE study
Figure 23.6: Comparison of five-year age-standardised relative survival from cancer of the bladder with other European countries (a) Male (b) Female
Northern Ireland Northern Ireland Austria Austria Czech Republic Czech Republic Denmark Denmark England England Estonia Estonia Finland Finland France France Germany Germany Iceland Iceland Italy Italy Malta Malta Netherlands Netherlands Norway Norway European country European country European Poland Poland Portugal Portugal Scotland Scotland Slovakia Slovakia Slovenia Slovenia Spain Spain Sweden Sweden Switzerland Switzerland Wales Wales EUROPE EUROPE
0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100% Five-year relative survival (%) Five-year relative survival (%)
Source: EUROCARE-3 (2003) 27,28
110
Cancer of the bladder illustrates that survival from this cancer was worse in Northern Ireland during the early 1990s than in the majority of countries in Europe and in Europe as a whole although survival was higher in Northern Ireland than in Slovenia (males only), Poland (males only) and Estonia. (Fig. 23.6)
Other countries Table 23.5: Five-year relative survival from cancer of Comparisons between Northern Ireland and other the bladder for various countries Period of countries illustrate that survival was lower in Northern Country Male Female diagnosis Ireland than in USA, Canada, Australia and New Northern Ireland 1997-2000 58.7% 45.9% Zealand. (Tab. 23.5) USA 1996-2002 82.8% 75.4% Canada 1995-1997 78.0% 74.0% 23.6: Summary and Discussion Australia 1992-1997 70.8% 64.7% New Zealand 1994-1999 74.9% 66.1% Survival from this disease in Northern Ireland is poor compared to other countries in Europe and is generally poorer for females than males and those aged 64- 99 compared to those aged 15-64. While the age discrepancy is usual for all types of cancer the male/female differences are uncommon but do occur throughout the UK and some European countries29. Work is ongoing to explain these gender differences.
The risk of developing cancer of the bladder is 1 in 71 for males and 1 in 245 for females. Tobacco use is the major established risk factor for this cancer94,95. The risk has been assessed as being four times higher in smokers versus non-smokers with the level of risk being linked to the length of time a person has smoked94. A diet high in fruit and vegetables has been linked to diminishing cancer risk96, while consumption of large quantities of coffee (10 or more cups per day) slightly increases the risk of developing this disease94.
Other environmental factors such as exposure to polyaromatic hydrocarbons94,97 and contaminants such as chlorine in drinking water may also increase incidence of bladder cancer. There is no evidence to suggest that a high intake of fluids decreases risk94.
Having had bladder infections or bladder stones in the past can increase the risk of developing particular types of bladder cancer94. The risk of developing a second bladder cancer is also higher than normal in cases where there is a past history of the disease94. There is no evidence however that this cancer is genetically related and a family history of bladder cancer does not increase the risk of it developing94.
Northern Ireland Cancer Registry 111
Survival of cancer patients in Northern Ireland: 1993-2004
24: CANCER OF THE BRAIN (C71) KEY FACTS: • 64 male and 48 female cases per year between 2000 and 2004 with no significant change in male or female incidence rates between 1993 and 2004; • 47 male and 34 female deaths per year between 2000 and 2004 with no significant change in male or female mortality rates between 1993 and 2004; • Survival similar in males and females: 17.0% of males and 21.0% of females alive after five years, with no significant change in survival between 1993-1996 and 1997-2000; • Survival similar to Scotland and Wales, but worse than USA and than in England and Europe for males.
24.1: Incidence and Mortality Incidence Brain cancer made up 1.4% of all cancers among males with an average of 64 new cases each year between 2000 and 2004 making it the fourteenth most common male cancer. Levels of new cases of brain cancer among females were less than that of males with 48 cases Table 24.1: Incidence and mortality: Cancer of the brain (2000-2004) diagnosed per year between 2000 Incidence Mortality and 2004. This was 1.1% of all Male Female Male Female female cancers ranking this cancer Number of cases/deaths per year 64 48 47 34 sixteenth among females. (Tab. Percentage of all cancers 1.4% 1.1% 2.5% 1.9% 24.1) Rank 14 16 11 11 Median age at diagnosis/death 58 60 60 64 Male to female ratio 1.3:1 - 1.4:1 - Incidence to mortality ratio 1.4:1 1.4:1 - - Mortality Crude rate per 100,000 persons 7.7 5.5 5.6 3.9 Brain cancer was the eleventh most European age-standardised rate 7.8 5.3 5.8 3.6 per 100,000 persons (95% CI) (6.9,8.7) (4.6,6.0) (5.0,6.5) (3.1,4.2) common cause of cancer death among males during 2000-2004 making up 2.5% of male cancer deaths (47 deaths annually). It was also the eleventh leading cause of cancer death among females making up 1.9% of the female cancer death total (34 deaths annually). Note that this includes malignant brain cancer only. Death can also occur from benign brain cancer. (Tab. 24.1)
Trends During 1993-2004 incidence and mortality rates (EASIR) for cancer of the brain varied considerably from year to year, with no significant trends for either sex during 1993-2004. Similarly there was little change over time in the average number of cases diagnosed or deaths from brain cancer. (Fig. 24.1; App. 4,5&6)
Figure 24.1: Incidence and mortality trends: Cancer of the brain (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
12 12 Male Male Female Female
10 10
8 8
6 6 persons persons
4 4
2 2 Age standardised mortality rate per 100,000 rate per Agemortality standardised Age standardised incidence per 100,000 rate
0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
112
Cancer of the brain
24.2: Relative Survival Relative survival from brain cancer was poor with 36.0% of patients diagnosed during 2001-2003 surviving one year and 18.8% of patients diagnosed between 1997 and 2000 surviving five years. (Tab. 24.2)
Table 24.2: Relative survival from cancer of the brain by sex and period of diagnosis (1993-2003) Survival time and RELATIVE SURVIVAL (95% CI) period of diagnosis Males Females All persons ALL PATIENTS 1993-1996 33.1% (26.6%, 39.6%) 32.9% (25.1%, 40.8%) 33.0% (28.0%, 38.0%) 1-year 1997-2000 35.1% (28.6%, 41.5%) 37.2% (29.9%, 44.5%) 36.0% (31.2%, 40.9%) 2001-2003 36.1% (29.1%, 43.0%) 35.8% (27.4%, 44.2%) 36.0% (30.6%, 41.3%)
1993-1996 15.9% (10.9%, 21.0%) 22.4% (15.4%, 29.3%) 18.6% (14.4%, 22.7%) 3-year 1997-2000 19.8% (14.4%, 25.3%) 23.3% (16.9%, 29.7%) 21.4% (17.2%, 25.6%)
1993-1996 12.5% (7.9%, 17.1%) 18.2% (11.7%, 24.7%) 14.9% (11.0%, 18.7%) 5-year 1997-2000 17.0% (11.7%, 22.2%) 21.0% (14.8%, 27.3%) 18.8% (14.8%, 22.8%)
Sex Males and females had similar survival Figure 24.2: Relative survival from cancer of the brain by sex and experience from brain cancer during period of diagnosis (1993-2000) 100% 1993-2003. For example, five-year Male (93-96) Female (93-96) relative survival for males diagnosed in 90% Male (97-00) 1997-2000 was 17.0% compared to Female (97-00) 80% 21.0% for females; a 4.0% difference which was not statistically significant 70%
(p>0.05). (Tab. 24.2; Fig. 24.2) 60%
50% Changes over time 40%
Male and female relative survival from Relative survival (%) brain cancer did not change 30% significantly during 1993-2003 20%
(p>0.05). (Tab. 24.2; Fig. 24.2) 10%
0% 24.3: International Comparisons 00 01 02 03 04 05 Time since diagnosis (years) EUROCARE-3 study The five-year age-standardised relative survival rate for males diagnosed in 1993-1996 was 11.1%, which was lower than in Europe as a whole during the early 1990s. A comparison with individual European countries illustrates that survival from brain cancer among males was significantly lower than many other European countries, in particular England, Finland, Norway, Spain, Sweden and Switzerland. For females the five-year age-standardised relative survival rate was 17.2%. This faired better than male survival during the early 1990s, with Europe as a whole having a similar survival rate. Female survival, however, was still significantly worse than in Finland, Norway and Iceland. (Fig. 24.3)
Other countries Table 24.3: Five-year relative survival from cancer of More recent results suggest that survival from brain the brain for various countries Period of cancer in Northern Ireland was poor compared to Country Male Female diagnosis survival in the USA and Australia. (Tab. 24.3) Northern Ireland 1997-2000 17.0% 21.0%
USA 1996-2002 29.3% 31.9% Canada 1995-1997 22.0% 25.0% Australia 1992-1997 23.8% 23.8% New Zealand 1994-1999 18.7% 17.4%
Northern Ireland Cancer Registry 113
Survival of cancer patients in Northern Ireland: 1993-2004
Figure 24.3: Comparison of five-year age-standardised relative survival from cancer of the brain with other European countries (a) Male (b) Female
Northern Ireland Northern Ireland Austria Austria Czech Republic Czech Republic Denmark Denmark England England Estonia Estonia Finland Finland France France Germany Germany Iceland Iceland Italy Italy Malta Malta Netherlands Netherlands Norway Norway European country European country European Poland Poland Portugal Portugal Scotland Scotland Slovakia Slovakia Slovenia Slovenia Spain Spain Sweden Sweden Switzerland Switzerland Wales Wales EUROPE EUROPE
0% 5% 10% 15% 20% 25% 30% 35% 40% 0% 5% 10% 15% 20% 25% 30% 35% 40% Five-year relative survival (%) Five-year relative survival (%)
Source: EUROCARE-3 (2003) 27,28
24.4: Summary and Discussion Cancer of the brain is one of the less common cancers making up less than 1.5% of male and female cancers. Levels of this disease have not changed over the last twelve years, a situation also found in the rest of the UK35. Survival from the disease in Northern Ireland is poor at approximately 19% of persons still alive after five years with no evidence existing of improvements over time. Survival in Northern Ireland appears to be similar to the rest of the UK but is worse than in many other European countries and the USA. The reasons for this are unknown and further investigation is required.
The only environmental factor associated with an increased risk of brain tumours is ionising radiation98,99. There are however some genetic (e.g. neurofibromatosis, tuberous sclerosis) and medical conditions (e.g. cerebral palsy in children) that increase risk by a small amount, as does a weakened immune system100. None of the following have a proven association; industrial and agricultural chemicals, viruses, bacterial infection, head injury, diet, non-ionising radiation (power lines, mobile phones) or tobacco98,100.
114
Hodgkin’s disease
25: HODGKIN’S DISEASE (C81) KEY FACTS: • 20 male and 16 female cases per year between 2000 and 2004 with no significant change in male or female incidence rates between 1993 and 2004; • 5 male and less than 5 female deaths per year between 2000 and 2004 with decreasing male (-5.5% p.a.) and no significant change in female mortality rates between 1993 and 2004; • Survival similar in males and females: 78.5% of males and 77.1% of females alive after five years, with no significant change in survival between 1993-1996 and 1997-2000; • Similar survival to other UK countries, Europe, USA, Canada and Australia.
25.1: Incidence and Mortality Incidence Hodgkin’s disease was the twentieth most common cancer in males and the twenty-first in females with an average of 20 males and 16 females diagnosed annually in Northern Ireland with the disease between 2000 and 2004. This cancer Table 25.1: Incidence and mortality: Hodgkin’s disease (2000-2004) occurred mostly in younger persons with a median age at Incidence Mortality Male Female Male Female diagnosis of 40 among males Number of cases/deaths per year 20 16 5 <5 and 36 among females. (Tab. Percentage of all cancers 0.4% 0.4% 0.3% - 25.1) Rank 20 21 18 - Median age at diagnosis/death 40 36 64 - Mortality Male to female ratio 1.2:1 - 1.7:1 - Incidence to mortality ratio 4.0:1 - - - Between 2000 and 2004 for Crude rate per 100,000 persons 2.4 1.9 0.6 - Hodgkin’s disease the number of European age-standardised rate 2.4 1.9 0.6 - male deaths was small at an per 100,000 persons (95% CI) (1.9,2.9) (1.5,2.3) (0.4,0.8) - average of 5 per year; 0.3% of male cancer deaths. The number of female deaths as a result of Hodgkin’s disease during this period was less than 5 per year. (Tab. 25.1)
Trends There were no statistically significant changes (p>0.05) in male incidence rates (EASIR) during 1993-2004 however male mortality rates (EASMR) decreased by 5.5% each year (p=0.023). There was an annual decrease in the number of cases and deaths among males as a result of this cancer of 0.7 cases and 0.2 deaths respectively. (Fig. 25.1; App. 4, 5 & 6)
Female incidence and mortality rates from Hodgkin’s disease remained static between 1993 and 2004 (p>0.05) although the actual number of deaths decreased annually by small amounts. (Fig. 25.1; App. 4, 5 & 6)
Figure 25.1: Incidence and mortality trends: Hodgkin’s disease (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
6 6 Male Male Female Female
5 5
4 4
3 3 persons persons
2 2
1 1 Age standardised mortality rate per 100,000 rate per Agemortality standardised Age standardised incidence rate per 100,000 Age incidence rate standardised
0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
Northern Ireland Cancer Registry 115
Survival of cancer patients in Northern Ireland: 1993-2004
25.2: Relative Survival Relative survival from Hodgkin’s disease was good with 92.1% of patients diagnosed between 2001 and 2003 surviving one year and 78.0% of patients diagnosed between 1997 and 2000 surviving five years. (Tab. 25.2)
Table 25.2: Relative survival from Hodgkin’s disease by sex and period of diagnosis (1993-2003) Survival time and RELATIVE SURVIVAL (95% CI) period of diagnosis Males Females All persons ALL PATIENTS 1993-1996 83.9% (76.0%, 91.8%) 90.3% (82.5%, 98.0%) 86.4% (80.7%, 92.1%) 1-year 1997-2000 87.7% (80.0%, 95.4%) 77.5% (65.9%, 89.0%) 83.5% (76.9%, 90.1%) 2001-2003 90.1% (81.2%, 99.0%) 94.0% (87.0%, 101.0%) 92.1% (86.4%, 97.8%)
1993-1996 76.1% (66.6%, 85.5%) 84.2% (74.5%, 93.9%) 79.3% (72.3%, 86.2%) 3-year 1997-2000 77.1% (67.1%, 87.1%) 78.3% (66.6%, 89.9%) 77.6% (70.0%, 85.2%)
1993-1996 71.3% (61.0%, 81.7%) 77.9% (66.8%, 89.0%) 73.9% (66.2%, 81.6%) 5-year 1997-2000 78.5% (68.3%, 88.7%) 77.1% (65.0%, 89.2%) 78.0% (70.2%, 85.8%)
Sex There were no significant differences in Figure 25.2: Relative survival from Hodgkin’s disease by sex and period relative survival from Hodgkin’s disease of diagnosis (1993-2000) between males and females (p>0.05) 100% during 1993-2003. In particular five- 90% year relative survival for those 80% diagnosed in 1997-2000 was 78.5% for males and 77.1% for females. (Tab. 70%
25.2; Fig. 25.2) 60%
50% Changes over time 40%
Relative survival from Hodgkin’s (%) survival Relative disease did not change significantly 30% during 1993-2003 (p>0.05). (Tab. 25.2; 20% Male (93-96) Fig. 25.2) Female (93-96) 10% Male (97-00) Female (97-00) 0% 25.3: International Comparisons 00 01 02 03 04 05 Time since diagnosis (years) EUROCARE-4 study The five-year age-standardised relative survival rate for males diagnosed between 1995 and 1999 was 78.7%, while for females the rate was 78.4%. A comparison with the countries included in the EUROCARE- 4 study illustrates that survival from Hodgkin’s disease in Northern Ireland was equivalent to that in the rest of Europe for both males and females with no significant differences between individual countries detected. Results for Germany, Iceland, Netherlands and Wales were not available due to insufficient cases. (Fig. 25.3)
Other countries Table 25.3: Five-year relative survival from Hodgkin’s Relative survival in Northern Ireland for those disease for various countries Period of diagnosed in 1997-2000 was lower than in USA, Country Male Female diagnosis Canada and Australia, although these differences Northern Ireland 1997-2000 78.5% 77.1% were not statistically significant due to the small USA 1996-2002 83.5% 86.6% number of cases in Northern Ireland (p>0.05). (Tab. Canada 1995-1997 85.0% 86.0% 25.3) Australia 1992-1997 82.6% 84.4% New Zealand 1994-1999 - -
116
Hodgkin’s disease
Figure 25.3: Comparison of five-year age-standardised relative survival from Hodgkin’s disease with other European countries (a) Male (b) Female
Northern Ireland Northern Ireland Austria Austria Belgium Belgium Czech Czech Denmark Denmark Finland Finland France France Germany Germany Iceland Iceland Ireland Ireland Italy Italy Malta Malta Netherlands Netherlands Norway Norway European country European country European Poland Poland Portugal Portugal Slovenia Slovenia Spain Spain Sweden Sweden Switzerland Switzerland UK_England UK_England UK_Scotland UK_Scotland UK_Wales UK_Wales EUROPE EUROPE
0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100% Five-year relative survival (%) Five-year relative survival (%)
Source:EUROCARE-4 (2007)29
25.4: Summary and Discussion Hodgkin’s disease is a cancer of the lymphatic system making up 13% of lymphomas, with the remainder being non-Hodgkin’s lymphoma. The risk of developing Hodgkin’s disease is low, being over 1 in 500, with rates of newly diagnosed cases of this cancer being higher in males than females. Incidence rates for Hodgkin’s disease were static in Northern Ireland, a result also observed in England and Wales. Both countries also have declining male mortality rates while England and Wales also has declining female mortality rates31.
Not much is known about the causes of this disease although two possible factors have been suggested; infection with Epstein-Barr virus and/or a faulty gene. Further research however is required before a definite link is established101.
Survival rates in Great Britain have steadily improved since the 1970s55. This improvement is also suggested by results in Northern Ireland; however further data is required for this result to become statistically significant.
Northern Ireland Cancer Registry 117
Survival of cancer patients in Northern Ireland: 1993-2004
26: NON-HODGKIN’S LYMPHOMA (C82-C85, C96) KEY FACTS: • 130 male and 136 female cases per year between 2000 and 2004 with no significant change in male or female incidence rates between 1993 and 2004; • 62 male and 61 female deaths per year between 2000 and 2004 with male mortality rates decreasing by 2.0% per year between 1993 and 2004 and no significant change in female mortality rates between 1999 and 2004; • Survival similar in males and females: 48.6% of males and 52.9% of females alive after five years, with one-year survival having improved for all persons from 64.9% to 72.3% between 1993-1996 and 2001-2003; • Survival better for those aged 15-64 than for those aged 65 and over; • Estimates using period analysis suggest that five-year survival will improve further for females diagnosed in 2001- 2004; • Survival similar to rest of UK and Europe but worse than USA.
26.1: Incidence and Mortality Incidence Among males non-Hodgkin’s lymphoma (NHL) was the seventh most common cancer contributing 2.9% of male cancers with an average of 130 new cases each year in 2000-2004. It was the seventh commonest cancer in females representing Table 26.1: Incidence and mortality: Non-Hodgkin’s lymphoma (2000-2004) 3.0% of female cancers with an annual average of 136 cases Incidence Mortality Male Female Male Female each year. (Tab. 26.1) Number of cases/deaths per year 130 136 62 61 Percentage of all cancers 2.9% 3.0% 3.3% 3.4% Mortality Rank 7 7 7 7 Median age at diagnosis/death 64 69 70 74 There was an average of 62 Male to female ratio 1.0:1 - 1.0:1 - male and 61 female deaths each Incidence to mortality ratio 2.1:1 2.2:1 - - year from non-Hodgkin’s Crude rate per 100,000 persons 15.6 15.6 7.4 7.0 lymphoma in 2000-2004. It was European age-standardised rate 16.0 13.1 7.5 5.3 the seventh commonest cause per 100,000 persons (95% CI) (14.8,17.3) (12.1,14.2) (6.6,8.3) (4.7,5.9) of cancer death among both males and females making up 3.3% of male and 3.4% of female cancer deaths. (Tab. 26.1)
Trends There was no significant trend in NHL incidence rates (EASIR) in 2000-2004, although the average number of cases diagnosed rose by 1.0 and 3.3 each year for males and females respectively. (Fig. 26.1; App. 4&6)
Male mortality rates (EASMR) decreased in 1993-2004 by 2.0% each year (p=0.05). Female EASMRs were static over the 1999 to 2004 period (p>0.05) after a significant increase of 14.1% each year in 1993-1999 (p=0.032). (Fig. 26.1; App. 5&6)
Figure 26.1: Incidence and mortality trends: Non-Hodgkin’s lymphoma (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
25 25 Male Male Female Female
20 20
15 15 persons persons 10 10
5 5 Age standardised mortality rate per 100,000 rate Agestandardised mortality Age standardised incidence rate per 100,000
0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
118
Non-Hodgkin’s lymphoma
26.2: Relative Survival Survival from non-Hodgkin’s lymphoma was moderate with one-year relative survival 72.3% for patients diagnosed in 2001-2003, while five-year relative survival was 50.8% for patients diagnosed in 1997-2000. (Tab. 26.2)
Table 26.2: Relative survival from non-Hodgkin’s lymphoma by sex and period of diagnosis (1993-2003) Survival time and RELATIVE SURVIVAL (95% CI) period of diagnosis Males Females All persons ALL PATIENTS 1993-1996 64.4% (59.8%, 69.0%) 65.5% (60.7%, 70.3%) 64.9% (61.6%, 68.2%) 1-year 1997-2000 68.8% (64.3%, 73.2%) 67.1% (62.7%, 71.4%) 67.9% (64.8%, 71.0%) 2001-2003 72.5% (67.5%, 77.5%) 72.1% (67.2%, 76.9%) 72.3% (68.8%, 75.8%)
1993-1996 52.4% (47.3%, 57.4%) 52.0% (46.7%, 57.2%) 52.2% (48.5%, 55.8%) 3-year 1997-2000 55.5% (50.5%, 60.5%) 56.5% (51.7%, 61.3%) 56.0% (52.6%, 59.5%)
1993-1996 46.2% (40.9%, 51.5%) 45.9% (40.5%, 51.3%) 46.1% (42.3%, 49.8%) 5-year 1997-2000 48.6% (43.3%, 53.9%) 52.9% (47.8%, 58.0%) 50.8% (47.2%, 54.5%)
7-year 1993-1996 43.5% (38.0%, 48.9%) 42.1% (36.6%, 47.7%) 42.8% (38.9%, 46.7%)
PATIENTS SURVIVING AT LEAST ONE YEAR (ONE-YEAR CONDITIONAL SURVIVAL) 1993-1996 81.0% (75.7%, 86.2%) 79.0% (73.6%, 84.5%) 80.0% (76.2%, 83.8%) 3-year* 1997-2000 80.4% (75.4%, 85.5%) 83.9% (79.2%, 88.5%) 82.2% (78.8%, 85.6%)
1993-1996 71.0% (64.7%, 77.4%) 69.5% (63.1%, 75.9%) 70.3% (65.8%, 74.8%) 5-year* 1997-2000 70.2% (64.1%, 76.4%) 78.0% (72.4%, 83.6%) 74.2% (70.0%, 78.4%)
7-year* 1993-1996 66.6% (59.7%, 70.5%) 63.5% (56.5%, 67.5%) 65.1% (60.2%, 70.0%) * from diagnosis Sex There were no statistically significant differences in one or five-year relative survival for males and females (p>0.05) diagnosed with non-Hodgkin’s lymphoma between 1993 and 2003. (Tab. 26.2; Fig. 26.2)
Changes over time One-year relative survival for all patients diagnosed with non-Hodgkin’s lymphoma improved during 1997- 2003 with 64.9% of patients diagnosed during 1993-1996 surviving one year compared to 72.3% of patients diagnosed during 2001-2003; a statistically significant difference of 7.4% (p=0.033). (Tab. 26.2; Fig. 26.2)
Figure 26.2: Relative survival from non-Hodgkin’s Figure 26.3: Relative survival from non-Hodgkin’s lymphoma by sex and period of diagnosis (1993-2000) lymphoma by period of diagnosis and whether or not patients survive at least one year (1993-2000) 100% 100%
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40%
Relative survival (%) 30% Relative survival (%) 30%
20% Male (93-96) 20% All (93-96) Female (93-96) Survived one-year (93-96) 10% Male (97-00) 10% All (97-00) Female (97-00) Survived one-year (97-00) 0% 0% 00 01 02 03 04 05 00 01 02 03 04 05 Time since diagnosis (years) Time since diagnosis (years)
Northern Ireland Cancer Registry 119
Survival of cancer patients in Northern Ireland: 1993-2004
There were no statistically significant changes in three or five-year relative survival for all patients or for males or females diagnosed with this cancer between 1993 and 2003 (p>0.05). (Tab.26.2;Fig.26.2)
Conditional survival Five-year relative survival from the date of diagnosis for the sub-group of patients who survived at least one-year from a diagnosis of non-Hodgkin’s lymphoma was 74.2%, while seven year survival was 65.1%. There were no significant differences between males and females or changes over time in this conditional survival (p>0.05). (Tab. 26.2; Fig. 26.3)
Age For patients diagnosed with NHL one Table 26.3: Relative survival from non-Hodgkin’s lymphoma by age and and five-year relative survival was period of diagnosis (1993-2003) better among those aged 15-64 than Survival time and RELATIVE SURVIVAL (95% CI) among those aged 65-99 regardless period of diagnosis Aged 15-64 Aged 65-99 of period of diagnosis (p<0.001). 1993-1996 78.8% (74.6%, 83.0%) 53.8% (49.1%, 58.5%) Relative survival for males and 1-year 1997-2000 79.4% (75.5%, 83.2%) 57.8% (53.2%, 62.3%) females aged 15-44 was also 2001-2003 81.5% (77.1%, 85.9%) 64.9% (59.8%, 69.9%) consistently better than for those 1993-1996 61.3% (56.2%, 66.5%) 33.2% (28.0%, 38.3%) aged 75 and over. (Tab. 26.3; Fig. 5-year 1997-2000 59.8% (55.0%, 64.6%) 42.8% (37.3%, 48.3%) 26.4)
One-year relative survival improved for 65-99 year olds during 1993-2003 with an increase of 11.1% between those diagnosed in 1993-1996 and 2001-2003. There were no other statistically significant changes over time in survival by age and sex. (Tab. 26.3; Fig. 26.4)
Figure 26.4: Relative survival from non-Hodgkin’s lymphoma by age, sex and period of diagnosis (1993-2003) (a) One-year (b) Five-year
100% 1993-1996 1997-2000 2001-2003 100% 1993-1996 1997-2000
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40% Relative survival (%) survival Relative
30% Relative survival (%) 30%
20% 20%
10% 10%
0% 0% Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female 15-44 45-54 55-64 65-74 75+ 15-44 45-54 55-64 65-74 75+ Sex and Age Sex and Age 26.3: Observed Survival One-year observed survival (which takes into account deaths from all causes and therefore is lower than relative survival) from non-Hodgkin’s lymphoma was 70.6% for male and 70.0% for female patients diagnosed between 2001 and 2003. Five-year observed survival was 42.1% for male and 46.2% for female patients diagnosed between 1997 and 2000. (Tab. 26.4)
Table 26.4: Observed survival from non-Hodgkin’s lymphoma by sex and period of diagnosis (1993-2003) Survival time and OBSERVED SURVIVAL (95% CI) period of diagnosis Males Females All persons 1993-1996 62.3% (57.8%, 66.7%) 63.7% (59.0%, 68.3%) 62.9% (59.7%, 66.1%) 1-year 1997-2000 66.8% (62.5%, 71.1%) 65.3% (61.1%, 69.5%) 66.0% (63.0%, 69.1%) 2001-2003 70.6% (65.8%, 75.5%) 70.0% (65.3%, 74.7%) 70.3% (66.9%, 73.7%)
1993-1996 39.3% (34.8%, 43.8%) 40.2% (35.5%, 45.0%) 39.7% (36.5%, 43.0%) 5-year 1997-2000 42.1% (37.5%, 46.7%) 46.2% (41.7%, 50.7%) 44.2% (41.0%, 47.4%)
120
Non-Hodgkin’s lymphoma
26.4: Period Analysis Figure 26.5: Estimated relative survival (period analysis) from non- Hodgkin’s lymphoma for patients diagnosed in 2001-2004 compared Five-year survival from non-Hodgkin’s with actual relative survival (cohort analysis) for patients diagnosed in lymphoma for patients diagnosed in 1997-2000.
2001-2004 derived using the period 100% analysis approach, in order to reflect more recent survival experiences, was 90% 53.4% for males and 57.5% for 80% females. The difference between males 70% and females was not statistically significant (p<0.05). (Fig. 26.5; App. 7) 60% 50% While not directly comparable with 40% results from traditional methods these Relative survival (%) survival Relative estimates represent an improvement in 30% survival for female patients compared 20% Male (97-00: Cohort analysis) to those diagnosed in 1993-1996 Female (97-00: Cohort analysis) 10% Male (01-04: Period analysis) (p>0.05). Changes in male survival Female (01-04: Period analysis) were not statistically significant 0% 00 01 02 03 04 05 (p<0.05). (App. 7) Time since diagnosis (years)
26.5: International Comparisons EUROCARE-3 study The five-year age-standardised relative survival rate from non-Hodgkin’s lymphoma was 43.7% while for females it was 48.6%. Both these rates are lower than that for Europe but not by a significant amount. Results from the EUROCARE-3 study indicate that five-year relative survival from this disease was better in Northern Ireland than in Poland but was worse than in Austria and Sweden for both sexes. Male survival in
Figure 26.6: Comparison of five-year age-standardised relative survival from non-Hodgkin’s lymphoma with other European countries (a) Male (b) Female
Northern Ireland Northern Ireland Austria Austria Czech Republic Czech Republic Denmark Denmark England England Estonia Estonia Finland Finland France France Germany Germany Iceland Iceland Italy Italy Malta Malta Netherlands Netherlands Norway Norway European country European Poland European country Poland Portugal Portugal Scotland Scotland Slovakia Slovakia Slovenia Slovenia Spain Spain Sweden Sweden Switzerland Switzerland Wales Wales EUROPE EUROPE
0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100% Five-year relative survival (%) Five-year relative survival (%) Source: EUROCARE-3 (2003) 27,28
Northern Ireland Cancer Registry 121
Survival of cancer patients in Northern Ireland: 1993-2004
Northern Ireland was also worse than in Spain while female survival was lower than that in Germany. (Fig. 26.6)
Other countries Table 26.5: Five-year relative survival from non- Five-year relative survival among males diagnosed with Hodgkin’s lymphoma for various countries Period of non-Hodgkin’s lymphoma during 1996-2000 was lower Country Male Female diagnosis than for males diagnosed with this disease in other Northern Ireland 1997-2000 48.6% 52.9% countries during the late 1990s. Five-year relative USA 1996-2002 60.4% 64.9% survival among females compared more favorably with Canada 1995-1997 53.5% 60.5% the situation in other countries but was still Australia 1992-1997 54.6% 55.8% considerably lower than in the USA and Canada. (Tab. New Zealand 1994-1999 54.0% 53.8% 26.5)
26.6: Summary and Discussion Non-Hodgkin’s lymphoma is one of the more common cancers being the seventh most common male and female cancer. Incidence of this cancer have remained fairly steady over time while male death rates have fallen, although both have been seen to increase in England and Wales32,35.
The risk of non-Hodgkin’s lymphoma is increased by the use of immunosuppression, for example in transplant patients, or among those with HIV infection, although only about 3% of HIV positive patients will develop non-Hodgkin’s lymphoma102,103. Both increase risk by a weakening of the immune system. Various other infections also increase the risk of developing this cancer. Epstein-Barr virus is associated with Burkitt’s lymphoma102, helicobacter pylori is linked with primary gastric lymphoma104, coliac disease is linked with both enteropathy type T cell lymphoma and B cell non-Hodgkin’s lymphoma while human T cell lymphoma increases the risk of developing any type of non-Hodgkin’s lymphoma102.
There are many other possible factors that increase the risk of developing this cancer; however these have yet to be substantiated. They include family history, diet and use of recreational drugs, exposure to agricultural chemicals or chemicals in drinking water, use of hair dye for more than 10 years or exposure to Hepatitis C102. It has been shown that there is no increased risk from cigarette smoking or alcohol consumption102.
Survival from this cancer is average with 49% of males and 53% of females who develop the disease surviving at least five years. Survival depends upon age with younger persons fairing better, however while survival in Northern Ireland is similar to that in the rest of the UK it is worse than some countries in Europe and the USA. Survival from this disease however is improving slowly with improvements in one-year survival identified in Northern Ireland. Similar improvements have also occurred in England and Wales55.
122
Multiple myeloma
27: MULTIPLE MYELOMA (C90) KEY FACTS: • 60 male and 46 female cases per year between 2000 and 2004 with no significant change in male or female incidence rates between 1993 and 2004; • 31 male and 29 female deaths per year between 2000 and 2004 with no significant change in male or female mortality rates between 1993 and 2004; • Survival similar in males and females: 29.0% of males and 35.7% of females alive after five years, with survival for 15-64 year olds having improved between 1993-1996 and 1997-2000; • Survival better for those aged 15-64 than for those aged 65 and over; • Survival similar to rest of UK, USA and Canada but worse than in France and Italy.
27.1: Incidence and Mortality Incidence Multiple myeloma accounted for 1.3% of male cancers diagnosed in 2000-2004. It was the sixteenth most common male cancer with an average of 60 cases per year. Multiple myeloma was less frequent among females with 46 cases diagnosed annually. It was the Table 27.1: Incidence and mortality: Multiple myeloma (2000-2004) seventeenth most common Incidence Mortality female cancer and made up Male Female Male Female 1.0% of cancer cases. (Tab. Number of cases/deaths per year 60 46 31 29 27.1) Percentage of all cancers 1.3% 1.0% 1.7% 1.6% Rank 16 17 15 15 Median age at diagnosis/death 70 74 75 78 Mortality Male to female ratio 1.3:1 - 1.1:1 - There were 31 male and 29 Incidence to mortality ratio 1.9:1 1.6:1 - - female deaths due to multiple Crude rate per 100,000 persons 7.2 5.3 3.8 3.3 myeloma each year between European age-standardised rate 7.2 4.0 3.7 2.3 per 100,000 persons (95% CI) (6.3,8.0) (3.5,4.6) (3.1,4.3) (1.9,2.7) 2000 and 2004. This represented 1.7% of male and 1.6% of female cancer deaths, with multiple myeloma being the fifteenth leading cause of cancer death among both males and females. (Tab. 27.1)
Trends Neither male nor female incidence rates (EASIR) exhibited a trend during 1993-2004 (p>0.05) although the number of male cases diagnosed rose by 1.3 each year. (Fig. 27.1; App. 4&6)
Mortality rates (EASMR) were also static over the 1993 to 2004 period with the annual change in the number of deaths being small for both sexes. (Fig. 27.1; App. 5&6)
Figure 27.1: Incidence and mortality trends: Multiple myeloma (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
12 12 Male Male Female Female
10 10
8 8
6 6 persons persons
4 4
2 2 Age rate standardisedper 100,000 mortality Age standardised incidence rate per 100,000
0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
Northern Ireland Cancer Registry 123
Survival of cancer patients in Northern Ireland: 1993-2004
27.2: Relative Survival Relative survival from multiple myeloma was moderately poor with 68.8% of patients diagnosed in 2001- 2003 surviving one year and 32.3% of patients diagnosed in 1997-2000 surviving five years. (Tab. 27.2)
Table 27.2: Relative survival from multiple myeloma by sex and period of diagnosis (1993-2003) Survival time and RELATIVE SURVIVAL (95% CI) period of diagnosis Males Females All persons ALL PATIENTS 1993-1996 59.4% (51.6%, 67.1%) 60.7% (53.1%, 68.3%) 60.1% (54.6%, 65.5%) 1-year 1997-2000 60.6% (53.5%, 67.7%) 61.1% (53.7%, 68.6%) 60.8% (55.7%, 66.0%) 2001-2003 69.5% (62.2%, 76.8%) 67.8% (58.9%, 76.7%) 68.8% (63.2%, 74.5%)
1993-1996 36.5% (28.4%, 44.5%) 36.4% (28.6%, 44.1%) 36.4% (30.8%, 42.0%) 3-year 1997-2000 37.3% (30.0%, 44.5%) 42.0% (34.1%, 49.8%) 39.5% (34.2%, 44.9%)
1993-1996 21.8% (14.6%, 29.1%) 23.8% (16.8%, 30.9%) 22.9% (17.8%, 27.9%) 5-year 1997-2000 29.0% (21.8%, 36.2%) 35.7% (27.8%, 43.7%) 32.3% (26.9%, 37.6%)
Sex Figure 27.2: Relative survival from multiple myeloma by sex and period of diagnosis (1993-2000) Among multiple myeloma patients 100% diagnosed in 1997-2000 survival did not differ significantly between males 90% and females with five-year relative 80% survival 29.0% for males compared to 70% 35.7% for females (p>0.05). (Tab. 27.2; Fig. 27.2) 60%
50%
Changes over time 40% Relative survival(%) Male and female relative survival from 30% multiple myeloma did not change 20% significantly during 1993-2003 Male (93-96) Female (93-96) 10% (p>0.05). (Tab. 27.2; Fig. 27.2) Male (97-00) Female (97-00) 0% 00 01 02 03 04 05 Age Time since diagnosis (years) For patients diagnosed with multiple myeloma in 1997-2000 five-year Table 27.3: Relative survival from multiple myeloma by age and period of relative survival among those aged diagnosis (1993-2003) 15-64 was 31.8% better than for Survival time and RELATIVE SURVIVAL (95% CI) those aged 65-99 (p<0.001). Similar period of diagnosis Aged 15-64 Aged 65-99 differences existed in one-year 1993-1996 82.5% (74.5%, 90.4%) 51.5% (45.0%, 58.1%) relative survival between these age 1-year 1997-2000 80.5% (73.0%, 88.1%) 52.8% (46.5%, 59.0%) groups for those diagnosed between 2001-2003 86.5% (79.0%, 93.9%) 61.4% (54.3%, 68.5%)
1993 and 2003. (Tab. 27.3) 1993-1996 32.6% (22.8%, 42.5%) 19.0% (13.2%, 24.8%) 5-year 1997-2000 54.4% (44.6%, 64.1%) 22.6% (16.5%, 28.6%) Five-year relative survival improved for 15-64 year olds diagnosed between 1993 and 2000 with 54.4% of those diagnosed between 1997-2000 surviving five years compared to 22.6% of those diagnosed in 1993-1996 (p=0.030). There were no changes in survival for 65-99 year olds over time (p>0.05). (Tab. 27.3)
27.3: International Comparisons EUROCARE-3 study The five-year age-standardised relative survival rate for males diagnosed between 1993 and 1996 was 21.6% while for females the rate was 25.2%. For both sexes this was lower than the five-year relative
124
Multiple myeloma survival rate in Europe (male 28.5%; female 33.0%) but not at a significant level. Significant differences between Northern Ireland and other European countries included in the EUROCARE-3 study include higher survival for patients living in France and Italy. (Fig. 27.3)
Figure 27.3: Comparison of five-year age-standardised relative survival from multiple myeloma with other European countries (a) Male (b) Female
Northern Ireland Northern Ireland Austria Austria Czech Republic Czech Republic Denmark Denmark England England Estonia Estonia Finland Finland France France Germany Germany Iceland Iceland Italy Italy Malta Malta Netherlands Netherlands Norway Norway European country European country European Poland Poland Portugal Portugal Scotland Scotland Slovakia Slovakia Slovenia Slovenia Spain Spain Sweden Sweden Switzerland Switzerland Wales Wales EUROPE EUROPE
0% 10% 20% 30% 40% 50% 60% 70% 80% 0% 10% 20% 30% 40% 50% 60% 70% 80% Five-year relative survival (%) Five-year relative survival (%)
Source: EUROCARE-3 (2003) 27,28
Other countries Table 27.4: Five-year relative survival from multiple Five-year relative survival in Northern Ireland for myeloma for various countries patients diagnosed between 1997 and 2000 was Period of Country Male Female slightly lower than in USA or Canada for males but diagnosis slightly higher for females, although this is not Northern Ireland 1997-2000 29.0% 35.7% conclusive due to the wide confidence intervals USA 1996-2002 35.4% 30.1% associated with the Northern Ireland estimates. (Tab. Canada 1995-1997 31.0% 32.0% 27.4) Australia 1992-1997 - - New Zealand 1994-1999 - - 27.4: Summary and Discussion Multiple myeloma is one of the less common cancers the levels of which are fairly static over time. Survival from the disease in Northern Ireland is moderately poor at approximately 32% of persons still alive after five years. Some evidence exists of improvements in survival although this is restricted to those aged 15-64 whose survival is generally better than those aged 65 and over. Survival in Northern Ireland appears to be similar to the rest of the UK and USA but is worse than in some European countries.
Few risk factors for this cancer have been established although an increased risk has been associated with radiation exposure and the medical condition known as Monoclonal Gammopathy of Unknown Significance, with 20-30% of sufferers from this condition eventually developing multiple myeloma105. This cancer is also more common in black populations105.
Northern Ireland Cancer Registry 125
Survival of cancer patients in Northern Ireland: 1993-2004
28: LEUKAEMIA (C91-C95; ADULTS ONLY) KEY FACTS: • 87 male and 64 female cases diagnosed each year during 2000-2004 with no significant change in male or female incidence rates during 1993-2004; • 52 male and 39 female deaths from the disease each year between 2000 and 2004 with an annual decrease of 2.9% in female and no significant change in male mortality rates during 1993-2004; • Five-year survival for patients diagnosed in 1997-2000 was 31.2% with no significant changes in five-year survival for patients diagnosed in 1997-2000 compared to those diagnosed in 1993-1996. There was no variation in survival by sex; • Survival was better for 15-64 year olds than for 65-99 year olds and varied considerably by cancer site (Five-year survival from acute myeloid leukaemia was 10.2% compared to 59.2% for chronic lymphocytic leukaemia); • Survival similar to rest of UK and Europe but lower than USA, Canada and Australia.
28.1: Incidence and Mortality Incidence Between 2000 and 2004 there were 87 male and 64 female cases of leukaemia diagnosed each year. It was the twelfth most frequently diagnosed male cancer making up 1.9% of newly diagnosed male cases. It was the thirteenth most common Table 28.1: Incidence and mortality: Leukaemia (2000-2004) female cancer making up 1.4% of female cancers. (Tab. 28.1) Incidence Mortality Male Female Male Female
Number of cases/deaths per year 87 64 52 39 Mortality Percentage of all cancers 1.9% 1.4% 2.7% 2.2% Deaths from leukaemia were Rank 12 13 10 9 Median age at diagnosis/death 67 69 71 76 more common in males than Male to female ratio 1.4:1 - 1.3:1 - females with an average of 52 Incidence to mortality ratio 1.7:1 1.7:1 - - male and 39 female deaths per Crude rate per 100,000 persons 10.5 7.4 6.2 4.4 year between 2000 and 2004 European age-standardised rate 10.6 6.1 6.3 3.2 making up 2.7% and 2.2% of all per 100,000 persons (95% CI) (9.6,11.6) (5.4,6.8) (5.5,7.1) (2.7,3.7) male and female cancer deaths respectively. It was the tenth most common cause of cancer death for males and the ninth for females. (Tab. 28.1)
Trends Incidence rates (EASIR) were static over the 1993-2004 period with no significant trend present (p>0.05) although the number of actual cases fell by 1.1 and 0.6 cases for males and females respectively. (Fig. 28.1; App. 4&6)
Female mortality rates (EASMR) declined during the twelve-year period by 2.9% each year (p=0.047) although the actual number of deaths remained static over time. Male EASMRs did not demonstrate any Figure 28.1: Incidence and mortality trends: Leukaemia (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
18 18
16 16
14 14
12 12
10 10
8 8 persons persons
6 6
4 4
2 2 Age standardised rate mortality per 100,000 Male
Age standardised incidence rate per 100,000 Male Female Female 0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
126
Leukaemia significant trend during 1993-2004 (p<0.05) with the number of deaths increasing by one every five years. (Fig. 28.1; App. 5&6)
28.2: Relative Survival Relative survival from leukaemia was moderately poor with 58.9% of patients diagnosed in 2001-2003 surviving one year and 31.2% of patients diagnosed in 1997-2000 surviving five years. (Tab. 28.2)
Table 28.2: Relative survival from leukaemia by sex and period of diagnosis (1993-2003) Survival time and RELATIVE SURVIVAL (95% CI) period of diagnosis Males Females All persons ALL PATIENTS 1993-1996 57.8% (51.9%, 63.6%) 54.4% (47.6%, 61.2%) 56.3% (51.9%, 60.8%) 1-year 1997-2000 52.4% (46.8%, 58.0%) 56.2% (49.6%, 62.7%) 54.0% (49.7%, 58.2%) 2001-2003 59.6% (52.6%, 66.6%) 58.0% (49.8%, 66.1%) 58.9% (53.6%, 64.2%)
1993-1996 40.8% (34.6%, 46.9%) 43.4% (36.2%, 50.6%) 41.9% (37.2%, 46.6%) 3-year 1997-2000 35.8% (30.2%, 41.4%) 40.6% (33.9%, 47.3%) 37.8% (33.5%, 42.1%)
1993-1996 30.0% (24.1%, 36.0%) 36.0% (28.7%, 43.3%) 32.6% (28.0%, 37.3%) 5-year 1997-2000 31.0% (25.3%, 36.7%) 31.6% (24.9%, 38.3%) 31.2% (26.9%, 35.6%)
7-year 1993-1996 26.6% (20.5%, 32.7%) 33.0% (25.6%, 40.5%) 29.4% (24.6%, 34.1%)
PATIENTS SURVIVING AT LEAST ONE YEAR (ONE-YEAR CONDITIONAL SURVIVAL) 1993-1996 70.2% (62.3%, 78.0%) 79.2% (70.7%, 87.8%) 73.9% (68.1%, 79.7%) 3-year* 1997-2000 68.0% (60.2%, 75.8%) 71.9% (63.3%, 80.4%) 69.7% (63.9%, 75.4%)
1993-1996 51.3% (42.5%, 60.2%) 65.2% (54.8%, 75.5%) 57.1% (50.3%, 63.8%) 5-year* 1997-2000 58.5% (49.7%, 67.3%) 55.6% (45.7%, 65.5%) 57.2% (50.6%, 63.8%)
7-year* 1993-1996 45.1% (35.9%, 54.4%) 59.4% (48.2%, 70.5%) 51.0% (43.9%, 58.2%) * from diagnosis Sex Patient survival from leukaemia was not dependent upon sex during the 1993-2003 period with 31.0% of males diagnosed with leukaemia between 1997 and 2000 surviving five years compared to 31.6% of females (p>0.05). (Tab. 28.2; Fig. 28.2)
Changes over time For male and female patients diagnosed with leukaemia between 1993 and 2003 there was little or no
Figure 28.2: Relative survival from leukaemia by sex and Figure 28.3: Relative survival from leukaemia by period period of diagnosis (1993-2000) of diagnosis and whether or not patients survive at least one year (1993-2000) 100% 100%
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40% Relative survival (%) Relative survival (%) 30% 30%
20% Male (93-96) 20% All (93-96) Female (93-96) Survived one-year (93-96) 10% Male (97-00) 10% All (97-00) Female (97-00) Survived one-year (97-00) 0% 0% 00 01 02 03 04 05 00 01 02 03 04 05 Time since diagnosis (years) Time since diagnosis (years)
Northern Ireland Cancer Registry 127
Survival of cancer patients in Northern Ireland: 1993-2004 improvement in survival over time with no statistically significant changes in one, three or five-year relative survival for the three consecutive periods of diagnosis (p>0.05). (Tab. 28.2; Fig. 28.2)
Conditional survival Five-year relative survival for leukaemia patients who survived one year from diagnosis and were diagnosed in 1997-2000 was 57.2% while seven-year survival for those diagnosed in 1993-1996 was 51.0%. This conditional survival rate did not vary by sex and there were no significant changes over time. (Tab. 28.2; Fig. 28.3)
Age For leukaemia patients diagnosed Table 28.3: Relative survival from leukaemia by age and period of during 1997-2000 five-year relative diagnosis (1993-2003) survival for those aged 15-64 was Survival time and RELATIVE SURVIVAL (95% CI) 22% better than for those aged 65- period of diagnosis Aged 15-64 Aged 65-99 99 (p<0.001). Differences also 1993-1996 64.8% (58.2%, 71.4%) 50.7% (44.9%, 56.6%) existed in one-year relative survival 1-year 1997-2000 65.9% (59.3%, 72.4%) 47.4% (42.0%, 52.7%) between these age groups 2001-2003 77.8% (70.7%, 84.8%) 47.0% (40.1%, 54.0%)
(p<0.028). There were no significant 1993-1996 39.4% (32.5%, 46.2%) 27.7% (21.5%, 33.9%) changes in survival for either 15-64 5-year 1997-2000 44.9% (37.8%, 52.0%) 22.9% (17.7%, 28.2%) or 65-99 year olds over time (p>0.05). (Tab. 28.3)
One-year survival for both males and females and five-year relative survival for females aged 75-99 who were diagnosed with leukaemia in 1997-2000 was significantly worse than for those aged 15-44 (p<0.05). For males aged 15-44 and 45-54 a significant improvement in one-year relative survival occurred between patients diagnosed in 1997-2000 and 2001-2003 (p=0.030; p=0.029). (Fig. 28.4; App. 8)
Figure 28.4: Relative survival from leukaemia by age, sex and period of diagnosis (1993-2003) (a) One-year (b) Five-year
100% 1993-1996 1997-2000 2001-2003 100% 1993-1996 1997-2000
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40% Relative survival (%) survival Relative 30% (%) survival Relative 30%
20% 20%
10% 10%
0% 0% Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female 15-44 45-54 55-64 65-74 75+ 15-44 45-54 55-64 65-74 75+ Sex and Age Sex and Age Note: Missing entries refer to less than 10 persons in that age/sex group Cancer site There are several types of leukaemia, with survival varying considerably by type. The most common form during 1993-2004 was acute myeloid leukaemia, making up 30% of all leukaemias. This type also had the worst survival with 10.2% of all persons diagnosed with this disease alive five years after a diagnosis in 1993-2000.
Table 28.4: Relative survival from leukaemia by cancer site (1993-2000) RELATIVE SURVIVAL (95% CI) Survival time Acute lymphoblastic Chronic lymphocytic Acute myeloid Chronic myeloid 1-year 52.2% (41.5%, 62.9%) 86.4% (82.2%, 90.6%) 27.9% (23.1%, 32.8%) 65.3% (56.3%, 74.4%)
5-year 24.1% (14.8%, 33.3%) 59.2% (52.5%, 65.9%) 10.2% (6.8%, 13.6%) 31.8% (22.0%, 41.7%)
128
Leukaemia
Chronic lymphocytic leukaemia made Figure 28.5: Relative survival from leukaemia by cancer site (1993- up 29% of leukaemias in Northern 2000) 100% Ireland with five-year relative survival Acute lymphoblastic Chronic lymphocytic Acute myeloid Chronic myeloid for patients diagnosed in 1993-2000 90% of 59.2%. The other two main types 80% are acute lymphoblastic leukaemia (15% of leukaemias) and chronic 70% myeloid leukaemia (10% of 60% leukaemias). These both had moderately poor five-year survival of 50% 24.1% and 31.8% respectively. (Tab. 40% Relative survival (%) survival Relative 28.4; Fig. 28.5) 30%
20% 28.3: Observed Survival 10% 0% One-year observed survival (which 00 01 02 03 04 05 takes into account deaths from all Time since diagnosis (years) causes and therefore is lower than relative survival) from leukaemia was 57.6% for male and 55.8% for female patients diagnosed between 2001 and 2003. Five-year observed survival was 25.6% for male and 26.9% for female patients diagnosed between 1997 and 2000. (Tab. 28.5)
Table 28.5: Observed survival from leukaemia by sex and period of diagnosis (1993-2003) Survival time and OBSERVED SURVIVAL (95% CI) period of diagnosis Males Females All persons 1993-1996 55.3% (49.7%, 61.0%) 52.5% (45.9%, 59.1%) 54.1% (49.8%, 58.4%) 1-year 1997-2000 50.3% (45.0%, 55.6%) 54.4% (48.1%, 60.7%) 52.0% (47.9%, 56.1%) 2001-2003 57.6% (50.8%, 64.3%) 55.8% (48.0%, 63.7%) 56.8% (51.7%, 61.9%)
1993-1996 24.3% (19.5%, 29.2%) 29.9% (23.8%, 35.9%) 26.7% (22.9%, 30.5%) 5-year 1997-2000 25.6% (20.9%, 30.3%) 26.9% (21.2%, 32.7%) 26.1% (22.5%, 29.8%)
28.4: Period Analysis Traditional methods for producing five- Figure 28.6: Estimated relative survival (period analysis) from year relative survival rates (cohort leukaemia for patients diagnosed in 2001-2004 compared with actual relative survival (cohort analysis) for patients diagnosed in 1997-2000. analysis) require five years worth of follow up data and thus do not reflect 100% more recent survival experience. More 90% up to date survival rates can be 80% estimated using newer techniques such as period analysis. 70%
60% Five-year survival from leukaemia for 50% males diagnosed in 2001-2004 derived using this approach was 37.9% while 40% Relative survival (%) survival Relative for females it was 36.1%. While not 30% directly comparable the results from the 20% Male (97-00: Cohort analysis) period analysis do not constitute a Female (97-00: Cohort analysis) significant difference from the actual 10% Male (01-04: Period analysis) Female (01-04: Period analysis) five-year relative survival derived using 0% cohort analysis for patients diagnosed 00 01 02 03 04 05 Time since diagnosis (years) in 1997-2000 (p>0.05). (Fig. 28.6; App. 7)
Northern Ireland Cancer Registry 129
Survival of cancer patients in Northern Ireland: 1993-2004
28.5: International Comparisons EUROCARE-3 study The European age-standardised five-year relative survival rate for leukaemia in Northern Ireland was 29.1% for males and 35.6% for females. For males this was significantly lower than the 36% for Europe as a whole but was similar to the 37% for European females. Some European countries demonstrated better male survival from leukaemia than in Northern Ireland, namely Austria, France, Spain, and Switzerland while male survival in Northern Ireland was better than that in Poland. For females Northern Ireland had worse survival than in France but better survival than in Malta and Poland. (Fig. 28.7)
Figure 28.7:Comparison of five-year age-standardised relative survival from leukaemia with other European countries (a) Male (b) Female
Northern Ireland Northern Ireland Austria Austria Czech Republic Czech Republic Denmark Denmark England England Estonia Estonia Finland Finland France France Germany Germany Iceland Iceland Italy Italy Malta Malta Netherlands Netherlands Norway Norway European country European country European Poland Poland Portugal Portugal Scotland Scotland Slovakia Slovakia Slovenia Slovenia Spain Spain Sweden Sweden Switzerland Switzerland Wales Wales EUROPE EUROPE
0% 10% 20% 30% 40% 50% 60% 70% 0% 10% 20% 30% 40% 50% 60% 70% Five-year relative survival (%) Five-year relative survival (%)
Source: EUROCARE-3 (2003) 27,28
Other countries Table 28.6: Five-year relative survival from leukaemia Male and female survival from leukaemia patients for various countries Period of diagnosed in the late 1990s was worse in Northern Country Male Female diagnosis Ireland than in USA, Canada, Australia and New Northern Ireland 1997-2000 31.0% 31.6% Zealand by at least 10% for males and 11% for USA 1996-2002 48.6% 47.8% females. (Tab. 28.6) Canada 1995-1997 46.0% 45.0% Australia 1992-1997 41.2% 43.2% New Zealand 1994-1999 48.3% 49.5% 28.6: Summary and Discussion Leukaemia refers to a group of diseases where white blood cells or their precursor cells multiply out of control preventing the bone marrow producing other essential cells such as red blood cells, platelets and normal white blood cells.
Over the last twelve years levels of leukemia have remained fairly static, a situation similar to the rest of the UK although over a longer period of time there has been a slow increase in incidence of this disease35. Mortality levels from leukaemia in Great Britain32 have been slowly declining with evidence of a definite decrease in Northern Ireland over the last twelve years in female deaths from this disease.
130
Leukaemia
Exposure to high levels of radiation increase the risk of developing acute leukaemia as does exposure to benzene106. Smokers also have a higher risk of developing acute myeloid leukaemia with smoking being responsible for 1 in 5 cases of this disease106. Other factors which increase risk include previous chemotherapy, blood disorders such as aplastic anaemia and myelodysplastic syndrome, inherited conditions such as Down’s syndrome and infections such as human T-cell leukaemia virus106. Little is known about the causes of chronic lymphocytic leukaemia although a possible risk factor is family history which may increase the risk of developing this leukaemia by a small amount107. Established risk factors of chronic myeloid leukaemia include exposure to high levels of radiation and exposure to benzene108.
Survival from this disease is low at around 31% of patients alive five years from diagnosis. The situation in Northern Ireland is slightly worse than in other countries although this is likely to be due to variations in the type of leukemia from country to country as leukaemia type has a significant impact on survival. While improvements in survival over the last decade have been slow, new treatment types may improve survival probability within the next decade; a prime example being the development of the Glivec drug which improves survival from chronic myeloid leukaemia109.
Northern Ireland Cancer Registry 131
Survival of cancer patients in Northern Ireland: 1993-2004
29: CHILDHOOD CANCER (Ages 0-14; All cancers excluding NMSC) KEY FACTS: • 24 cases per year among boys and 21 among girls between 2000 and 2004 with no significant trends in incidence rates between 1993 and 2004; • 6 deaths per year among boys and less than 5 among girls during 2000-2004 with no significant trends in mortality rates between 1993 and 2004; • Survival similar in boys and girls: 74.0% of boys and 75.5% of girls alive after five years, with no significant change in survival between 1993-1996 and 1997-2000; • Survival for at least one-year from diagnosis did not significantly improve long-term survival; • Survival from leukaemia better (79.5% after five years) than survival from brain cancer (57.4% after five years).
29.1: Incidence and Mortality Incidence There were on average 24 boys and 21 girls diagnosed with cancer each year in 2000-2004, representing 0.5% of all male and female cancers. The two main types of childhood cancer were leukaemia and cancer of the brain, respectively making Table 29.1: Incidence and mortality: Childhood cancer (2000-2004) up 32% and 24% of childhood cancers with an average of 14 Incidence Mortality Boys Girls Boys Girls childhood leukaemia and 11 Number of cases/deaths per year 24 21 6 <5 childhood brain cancers each Percentage of all cancers 0.5% 0.5% 0.3% - year. (Tab. 29.1) Male to female ratio 1.1:1 - 2.7:1 - Incidence to mortality ratio 3.7:1 8.6:1 - - Crude rate per 100,000 persons 12.6 11.6 3.4 - Mortality European age-standardised rate 12.9 12.0 3.5 - per 100,000 persons (95% CI) (10.6,15.3) (9.7,14.3) (2.3,4.7) - Annually there were 6 boys and less than 5 girls who died of some form of cancer between 2000 and 2004. This represented less than 0.5% of all male and female cancer deaths with one death occurring for every 3.7 new cancers among boys. (Tab. 29.1)
Trends Incidence rates of childhood cancer for both girls and boys remained in a steady state during 1993-2004 (p>0.05). The number of cases among boys decreased annually by just less than one case between 1993 and 2004 while the annual change in cases for girls was close to zero. (Fig. 29.1; App. 4&6)
No significant trend in mortality rates was present between 1993 and 2004 (p>0.05) with the annual change in the number of deaths being very small for both sexes. (Fig. 29.1; App. 5&6)
Figure 29.1: Incidence and mortality trends: Childhood cancer (1993-2004) (a) European age-standardised incidence rates (b) European age-standardised mortality rates
30 30 Boys Boys Girls Girls
25 25
20 20
15 15 persons persons
10 10
5 5 Age standardised mortality rate per 100,000 rate per 100,000 Age standardised mortality Age standardised incidence rate per 100,000 Age incidence rate standardised
0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Year of death
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Childhood cancer
29.2: Relative Survival Relative survival from childhood cancer was good with 90.6% of patients diagnosed between 2001 and 2003 surviving one year and 74.6% of patients diagnosed between 1997 and 2000 surviving five years. (Tab. 29.2)
Table 29.2: Relative survival from childhood cancer by sex and period of diagnosis (1993-2003) Survival time and RELATIVE SURVIVAL (95% CI) period of diagnosis Boys Girls All children ALL PATIENTS 1993-1996 91.8% (86.9%, 96.7%) 89.2% (82.8%, 95.6%) 90.7% (86.8%, 94.6%) 1-year 1997-2000 91.1% (85.8%, 96.4%) 85.2% (77.1%, 93.3%) 88.8% (84.2%, 93.3%) 2001-2003 88.4% (80.9%, 96.0%) 92.7% (86.5%, 98.9%) 90.6% (85.6%, 95.5%)
1993-1996 81.9% (75.0%, 88.8%) 79.4% (71.2%, 87.7%) 80.8% (75.5%, 86.1%) 3-year 1997-2000 79.6% (72.1%, 87.0%) 78.5% (69.1%, 87.9%) 79.1% (73.3%, 85.0%)
1993-1996 73.7% (65.8%, 81.6%) 76.2% (67.5%, 84.9%) 74.8% (68.9%, 80.6%) 5-year 1997-2000 74.0% (65.8%, 82.2%) 75.5% (65.6%, 85.4%) 74.6% (68.3%, 80.9%)
7-year 1993-1996 71.3% (63.2%, 79.4%) 76.2% (67.5%, 85.0%) 73.4% (67.4%, 79.4%)
PATIENTS SURVIVING AT LEAST ONE YEAR (ONE-YEAR CONDITIONAL SURVIVAL) 1993-1996 84.4% (77.9%, 90.9%) 84.9% (77.5%, 92.2%) 84.6% (79.7%, 89.4%) 3-year* 1997-2000 83.1% (76.2%, 90.1%) 81.2% (72.2%, 90.1%) 82.3% (76.8%, 87.8%)
1993-1996 73.7% (65.8%, 81.5%) 77.3% (68.7%, 85.9%) 75.2% (69.4%, 81.0%) 5-year* 1997-2000 76.0% (68.1%, 83.9%) 78.5% (69.1%, 87.9%) 77.0% (70.9%, 83.1%)
7-year* 1993-1996 72.9% (64.9%, 80.8%) 76.2% (67.5%, 84.9%) 74.3% (68.4%, 80.2%) * from diagnosis Sex There were no statistically significant differences in one or five-year relative survival for boys and girls (p>0.05) diagnosed with cancer between 1993 and 2003. (Tab 29.2; Fig.29.2)
Changes over time The survival experience of children diagnosed with cancer has not changed over time with, for example, five-year relative survival for all children diagnosed in both 1993-1996 and 1997-2000 being just under 75%. (Tab. 29.2; Fig. 29.2)
Figure 29.2: Relative survival from childhood cancer by Figure 29.3: Relative survival from childhood cancer by sex and period of diagnosis (1993-2000) period of diagnosis and whether or not patients survive at least one year (1993-2000) 100% 100%
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
40% 40% Relative survival (%) 30% Relative survival (%) 30%
20% Boys (93-96) 20% All (93-96) Girls (93-96) Survived one-year (93-96) 10% Boys (97-00) 10% All (97-00) Girls (97-00) Survived one-year (97-00) 0% 0% 00 01 02 03 04 05 00 01 02 03 04 05 Time since diagnosis (years) Time since diagnosis (years)
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Conditional survival For children diagnosed with cancer during 1997-2000 who survived at least one-year after diagnosis 77.0% survived five-years from their date of diagnosis. This proportion was not significantly different than the five- year relative survival rate for all persons indicating that surviving one-year from diagnosis did not significantly improve the long-term survival of children with cancer. (Tab. 29.2; Fig.29.3)
Table 29.3: Relative survival from childhood cancer by cancer site Cancer site (1993-2000) For children (aged 0 to 14) diagnosed Survival RELATIVE SURVIVAL (95% CI) with cancer of the brain between 1993 time Brain Leukaemia and 2000 one-year relative survival was 1-year 76.3% (67.0%, 85.6%) 93.9% (90.0%, 97.8%) 76.3% while for children diagnosed in the same time period survival after five years 5-year 57.4% (46.6%, 68.3%) 79.5% (72.9%, 86.1%) was 57.4%. Relative survival from leukaemia among children was good with 93.9% of children diagnosed Figure 29.4: Relative survival from childhood cancer by cancer site (1993-2000) between 1993 and 2000 surviving one 100% year and 79.5% of children surviving five years. Differences in survival 90% between brain cancer and leukaemia 80% were statistically significant (p=0.013). Leukaemia (Tab. 29.3; Fig. 29.4) 70% 60% Brain 29.3: Summary and Discussion 50%
Cancer affects a small number of 40%
children in Northern Ireland each year, Relative survival(%) 30% the exact causes of which are as yet unknown. Some factors associated with 20% a higher risk of cancer in children which 10% have been identified include some 0% inherited conditions (such as Down’s 00 01 02 03 04 05 syndrome), problems with development Time since diagnosis (years) in the womb, exposure to infections such as Epstein-Barr virus and exposure to radiation110. To date there is no evidence to suggest that exposure to electromagnetic fields increases the likelihood of children developing cancer110.
Childhood cancer in Britain has been rising since 1962 by an average of 0.8% each year while deaths among children from cancer have fallen by 2.6% per year due to improvements in survival since the 1960s as a result of the introduction of combination chemotherapy111. Trends in Northern Ireland however remain in a steady state with no changes in incidence or mortality over time. This is probably due to the small number of cases in Northern Ireland and the availability of only twelve years of cancer incidence data.
Approximately 75% of all children with cancer survive at least five years, a similar proportion to the survival rate in England111, with no difference in survival between boys and girls and no improvements over the last ten years. Leukaemia and brain cancer make up almost 60% of all childhood cancers with survival from leukaemia better than that from brain cancer (based on those diagnosed between 1993 and 2000).
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Abbreviations
A1: ABBREVIATIONS
AIHW Australian Institute of Health and Welfare APC Annual Percentage Change ASR Age-Standardised Rate CI Confidence Interval CCPS Centre for Clinical & Population Sciences CCS Canadian Cancer Society COA Census Output Area CPD Central Postcode Directory DCO Death Certificate Only DHSSPSNI Department of Health, Social Services and Public Safety, Northern Ireland EASR European Age-Standardised Rate EASIR European Age-Standardised Incidence Rate EASMR European Age-Standardised Mortality Rate EU European Union FAP Familial Adenomatous Polyposis GAD Government Actuary Department GRO General Registrar Office (Northern Ireland) ICD10 International Classification of Diseases, Version 10 ISD Information Services Department, Scotland HNPCC Hereditary Non-Polyposis Colorectal Cancer HPV Human Papillomavirus HRT Hormone Replacement Therapy LGD Local Government District NCI National Cancer Institute, USA NCRI National Cancer Registry, Ireland NHL Non-Hodgkin’s Lymphoma NI Northern Ireland NICR Northern Ireland Cancer Registry NISRA Northern Ireland Statistics and Research Agency NMSC Non-Melanoma Skin Cancer NSCLC Non-Small Cell Lung Cancer NZHIS New Zealand Health Information Service ONS Office of National Statistics QUB Queen’s University, Belfast ROI Republic of Ireland SCLC Small Cell Lung Cancer SIR Standardised Incidence Ratio SMR Standardised Mortality Ratio TVO Tumour Verification Officer UKACR United Kingdom Association of Cancer Registries UV Ultraviolet WCISU Welsh Cancer Intelligence and Surveillance Unit
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A2: DEFINITIONS
Annual Percentage Change (APC): The percentage increase or decrease per year in the age-standardised rate (ASR). It is calculated by fitting a regression line to the natural logarithm of the rates using calendar year as a regression variable, i.e. y = mx + b, where y = ln(ASR), x is the calendar year, and b is a constant. The annual percentage change (APC) is thus given by APC = 100× (e m −1) The calculation assumes that the age-standardised rates increase or decrease at a constant rate over the period examined.
Age-Specific Rate: The rate per 100,000 persons for a particular age group. It is calculated using the following formula:
ri ai = ×100,000 ni where ai is the age-specific rate for age group i, ri is the number of cases in age group i and ni is the number of persons in age group i.
Age-Standardised Rate (ASR): The rate per 100,000 persons that has been adjusted to take account of different age structures between geographic areas or time periods by adopting a reference population. It is calculated by the direct method using the following formula: A ∑ ai wi i=1 ASR = A ∑ wi i=1 where ASR is the age-standardised rate, ai is the age-specific rate for age group i, wi is the standard population of age group i and A is the number of age intervals.
Behaviour: The manner in which a tumour acts, i.e. benign, in-situ or malignant.
Benign Tumour: A tumour which does not invade or destroy the tissue in which it originates, or spread to distant sites in the body.
Cancer: A disease resulting from the breakdown in the normal growth of body cells as a result of faults or damage to the genes that control for cell growth.
Cancer Site: The body place that a cancer originates in, e.g. lung, breast or prostate.
Cell Type: Cancers can be classified according to the type of cell that the tumour resembles. The most common categories include: carcinoma, lymphoma, leukaemia, sarcoma and glioma. Carcinomas represent the most common cancers with sub categories frequently used including adenocarcinoma, squamous cell carcinoma, basal cell carcinoma, small-cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC).
Censor Date: The date at which a patient was last known to be alive or dead.
Census Output Area (COA): The smallest geographic area commonly used in Northern Ireland. Census Output Areas are derived from the results of the 2001 Census and aggregate exactly to Electoral Ward and Local Government District. There are 5,022 COAs in Northern Ireland with an average of 335 persons resident in each area9.
Cohort Analysis: The traditional method of survival analysis which is based upon the survival experience of patients diagnosed with cancer during a particular period of time and who have been followed up until the most recent date possible. See observed and relative survival.
136
Definitions
Comorbidity: The presence of one or more disorders (or diseases) in addition to a primary disease or disorder.
Conditional Survival: The probability of survival given that survival for a certain length of time has already occurred.
Confidence Interval: The range of values calculated to have a specified (usually 95%) probability of containing the true value of an observation. Thus the 95% confidence interval for a survival rate is the range of values within which there is a 95% probability of finding the true value for the survival rate.
Crude Rate: The rate per 100,000 persons that an event occurs among a given population. It is calculated by using the formula: R C = ×100,000 N where C is the crude rate, R is the number of events and N is the population within which the events occur.
Deprivation Quintile: The division of the 5,022 Census Output Areas in Northern Ireland into five groups of approximately equal population based upon their level of economic deprivation. They are derived using the 2005 NI Noble deprivation measures7. Quintile 5 contains the fifth of the population resident in the least deprived COAs and quintile 1 contains the fifth of the population resident in the most deprived COAs.
Diagnosis: The process whereby the nature of a patient’s illness is identified through medical examination.
District Council: See Local Government District.
Ederer II Method: A method for calculating expected survival using life table data. See reference 14.
European Standard Population: A standard population using the age distribution per 100,000 persons given in table A2.1: The same age distribution is used for males and females.
Table A2.1: European standard population Age Group Population Age Group Population Age Group Population Age Group Population 0-4 8,000 25-29 7,000 50-54 7,000 75-79 2,000 5-9 7,000 30-34 7,000 55-59 6,000 80-84 1,000 10-14 7,000 35-39 7,000 60-64 5,000 85+ 1,000 15-19 7,000 40-44 7,000 65-69 4,000 20-24 7,000 45-49 7,000 70-74 3,000 Total 100,000
Expected Survival: The survival expected from of a group of patients based upon the life table of the general population from which they are diagnosed.
Hybrid-Period Analysis: A modification of period analysis in which data on the survival experience of patients diagnosed with cancer prior to the period being investigated in used. See reference 16.
ICD10: The tenth edition of the International Statistical Classification of Diseases and Related Health Problems, which is published by the World Health Organisation (WHO). It provides a detailed description of known diseases and injuries and is used in the production of morbidity and mortality statistics. See reference 5.
Incidence: The number of new cases of a cancer diagnosed in a particular period for a particular population.
Incidence to Mortality Ratio: The ratio of the number of newly diagnosed cancers in a given year to the number of deaths due to cancer in the same year.
In-situ Tumour: An early cancer that has not spread to neighbouring tissue.
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Kaplan-Meier method: See observed survival.
Life Table: A table that shows the life expectancy of a person at each age and sex. Also included in Northern Ireland life tables are: • the probability that a person of a given age will die before their next birthday; • the number of people out of 100,000 live births who survive to a given age; • the number of people who die at a given age.
Local Government District (LGD): A geographic area in Northern Ireland defined for Local Government purposes. There are currently 26 Local Government Districts in Northern Ireland. It is expected that the number of Local Government Districts will be reduced in 2009 as part of the Review of Public Administration. LGDs are also referred to as District Councils.
Log-Linear Model: A mathematical model in which a continuous variable, y, is related to an explanatory variable, x, by the following equation: Ln(y) = mx + b, where b is a constant value.
Malignant Tumour: A cancerous tumour that can invade and destroy nearby tissue and spread to other parts of the body.
Mid-year Population Estimate: An estimate of the population in a region. This is based upon the number of births, deaths and the migration flows for the region that have occurred since the last population census.
Mortality: For the purposes of this report mortality refers to the number of patients whose primary cause of death for a particular period was cancer. In a wider context this refers to all causes of death.
Neoplasm: See Tumour.
Observed Survival: The probability that a patient with a given disease will be alive at the end of a time period, i, measured from the date of diagnosis. It is determined using the formula: i d j S = 1− i ∏ 1 j=1 n j − 2 w j where j is the observed period of death, dj is the number of deaths from any cause occurring during period j, nj is the number of patients alive entering period j and wj is the number of patients withdrawn alive (censored) during the jth period.
Passive Follow-up: A method of cancer registration in which the status of patients is identified by the matching of cancer registrations with death registrations. This approach is used in Northern Ireland with deaths data supplied by the General Registrar Office.
Pathology: The identification of a disease through microscopic examination of cells and tissue.
Period Analysis: An approach used to estimate patient survival for more recent periods of time, which cannot be obtained using cohort analysis due to insufficient follow up time. This approach utilises the survival experience of patients still alive in the period of interest rather than of those diagnosed during the period. See reference 15.
P-value: The probability of an event occurring given a null hypothesis is true. In any statistical tests in this report the null hypothesis is taken to be that there is no difference between two mean values or rates. A small p-value (typically less than 0.05) suggests that the two means or rates tested are significantly different.
Relative Survival: The ratio of the observed survival of a given group of patients to the expected survival for a group of persons in the general population with the same characteristics (usually sex and age).
138
Definitions
Settlement Band: An eight-band urban/rural classification for areas in Northern Ireland. The bands used are as follows: (A) Belfast Metropolitan Urban Area; (B) Derry Urban Area; (C) Large town (population 18,000 or more); (D) Medium town (population 10,000 or more, but under 18,000); (E) Small town (population 4,500 or more, but under 10,000); (F) Intermediate settlement (population 2,250 or more, but under 4,500); (G) Village (population 1,000 or more, but under 2,250); (H) Small village, hamlet and open countryside (population under 1,000). Bands A to E are classified as urban settlements and bands F to H are classified as rural settlements.
Staging: A measure of how far a malignancy has spread in the body. The higher the stage the greater the disease has spread and the less favourable the prognosis for the patient. See appendix 3 for staging of individual cancer sites.
Standardised Incidence Ratio (SIR): The ratio of the number of newly diagnosed cancers observed in a given population to the number of cases expected in a reference population of the same size. The expected number of incidence is calculated by applying a standard set of age specific rates to the given population. The formula for the standardised incidence ratio (SIR) is: A ∑ ri SIR = i=1 A a n ∑ i i i=1 100,000 where ai is the age specific rate in the reference population, ni is the observed population in age group i and ri is the observed number of cases in age group i.
Standardised Mortality Ratio (SMR): The ratio of the number of cancer deaths observed in a given population to the number of deaths expected in a reference population of the same size. The SMR is calculated in the same manner as the standardised incidence ratio using deaths due to cancer instead of the number of newly diagnosed cases.
Survival Curve: A plot of survival probability against time.
Tumour: An abnormal mass of tissue resulting from uncontrolled cell growth and causing a swelling of the body. Tumours may be benign or malignant.
Vital Status: Whether or not a patient is alive or dead at the censor date.
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A3: STAGING
The stage of a tumour is a measure of how far a malignancy has spread in the body. The higher the stage the greater the disease has spread and the less favourable the prognosis for the patient.
Staging is carried out using a number of laboratory and clinical tests at diagnosis. The most commonly used staging classification is the TNM stage that includes information on the extent of the primary tumour (T), the absence or presence of lymph node metastasis (N) and the absence or presence of distant metastasis (M). The classification combines these three elements to produce an overall TNM stage for the tumour. However the manner in which the overall TNM stage is derived depends upon the cancer site. A comparison of how this differs between cancer sites is shown below. For a more detailed description of staging see reference 112.
Colorectal cancer Stage group T N M T1: Tumour invades submucosa T2: Tumour invades muscularis propria I T1 N0 M0 T3: Tumour invades through the muscularis propria into the subserosa T2 N0 M0 T4: Tumour invades directly invades other organs or structures and/or perforates visceral peritoneum IIA T3 N0 M0 N0: No regional lymph nodes involved IIB T4 N0 M0 N1: 1-3 regional lymph nodes involved IIIA T1-T2 N1 M0 N2: More than 4 regional lymph nodes involved M0: No distant metastases IIIB T3-T4 N1 M0 M1: Distant metastases IIIC Any T N2 M0 IV Any T Any N M1
The modified Dukes classification system is sometimes used to stage colorectal cancer as an alternative to the TNM stage. The two systems however are related in the following manner • Dukes Stage A = Stage I; • Dukes Stage B = Stage IIA & Stage IIB; • Dukes Stage C = Stage IIIA, Stage IIIB & Stage IIIC; • Dukes Stage D = Stage IV.
Malignant melanoma Stage group T N M T1: Tumour invades papillary dermis T2: Tumour invades papillary-reticular interface I T1 N0 M0 T3: Tumour invades reticular dermis II T2 N0 M0 T4: Tumour invades subcutaneous tissue N0: No regional lymph nodes involved III T3 N0 M0 N1: Regional lymph nodes involved IV T4 N0 M0 M0: No distant metastases Any T N1 M0 M1: Distant metastases Any T Any N M1
Two alternative classifications are in frequent use for malignant melanoma. The Clark’s level is equivalent to the TNM stage with an additional category for early in-situ tumours. Thus • Clark’s Level I = Early in-situ tumour with no nodal involvement or metastatic spread; • Clark’s Level II = Stage I; • Clark’s Level III = Stage II; • Clark’s Level IV = Stage III; • Clark’s Level V = Stage IV.
The second classification in common use is the Breslow Depth. This classification is unrelated to the TNM stage and records the depth of the tumour. In this report the following categories: 0.00-0.75mm, 0.76- 1.50mm, 1.51-3.00mm and greater than 3.00mm are used.
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Staging
Breast cancer Stage group T N M T0: No evidence of primary tumour T1: Tumour 2cm or less in greatest dimension I T1 N0 M0 T2: Tumour more than 2cm but less than 5cm in greatest dimension IIA T0 N1 M0 T3: Tumour more than 5cm in greatest dimension T4: Tumour of any size with direct extension to chest wall or skin T1 N1 M0 N0: No regional lymph nodes involved T2 N0 M0 N1: 1-3 axiliary lymph nodes involved IIB T2 N1 M0 N2: 4-9 axiliary lymph nodes involved N3: More than 10 axiliary lymph nodes involved or metastases in infraclavicular nodes T3 N0 M0 M0: No distant metastases IIIA T0 N2 M0 M1: Distant metastases T1-T2 N2 M0 T3 N1-N2 M0 IIIB T4 N0-N2 M0 IIIC Any T N3 M0 IV Any T Any N M1
For statistical analysis the different breast cancer stages are combined into four stages, ranging from early tumours (Stage I) to advanced tumours that have distant metastasis (Stage IV).
Cervical cancer Stage group T N M T1: Tumour confined to uterus T2: Tumour invades beyond the uterus but no to the pelvic wall or lower third of the vagina I T1 N0 M0 T3: Tumour extends to pelvic wall and/or involves lower third of the vagina and/or causes II T2 N0 M0 hydronephrosis or defunctioning kidney T4: Tumour invades mucosa of bladder or rectum, and/or extends beyond the pelvis III T1 N1 M0 N0: No regional lymph nodes involved T2 N1 M0 N1: Regional lymph nodes involved T3 Any N M0 M0: No distant metastases M1: Distant metastases IV T4 Any N M0 Any T Any N M1
Ovarian cancer Stage group T N M T1: Tumour limited to ovaries (one or both) T2: Tumour limited to ovaries with pelvic extension and/or implants I T1 N0 M0 T3: Tumour involves one or both ovaries with microscopically confirmed peritoneal II T2 N0 M0 metastases outside the pelvis N0: No regional lymph nodes involved III T3 N0 M0 N1: Regional lymph nodes involved Any T N1 M0 M0: No distant metastases IV Any T Any N M1 M1: Distant metastases
The FIGO classification uses staging categories accepted by the Federation International de Gynecologie et d’Obstetrique to stage cervical and ovarian cancers. The FIGO categories are roughly equivalent to Stages I-IV of the TNM classification but do not include nodal involvement. Thus • FIGO Stage I = Stage I • FIGO Stage II = Stage II • FIGO Stage III = Stage III • FIGO Stage IV = Stage IV
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A4: INCIDENCE RATES BY SEX AND CANCER SITE (1993-2004)
All cancers including non-melanoma skin cancer (C00-C97) Male Female Year of %cancer Crude EASR 95% %cancer Crude EASR 95% diagnosis Cases EASR Cases EASR cases rate CI cases rate CI 1993 4,123 100.0% 516.5 569.4 552.0,586.8 4,276 100.0% 510.7 451.3 437.1,465.5 1994 4,163 100.0% 519.1 569.3 552.0,586.6 4,153 100.0% 493.4 438.5 424.4,452.5 1995 4,077 100.0% 507.1 551.5 534.6,568.5 4,205 100.0% 497.6 439.5 425.6,453.5 1996 4,238 100.0% 523.0 562.5 545.5,579.4 4,419 100.0% 519.0 451.8 437.8,465.8 1997 4,164 100.0% 510.6 546.9 530.2,563.5 4,366 100.0% 510.2 440.4 426.7,454.1 1998 4,234 100.0% 517.2 548.2 531.7,564.7 4,394 100.0% 511.5 444.9 431.1,458.6 1999 4,201 100.0% 513.3 536.7 520.5,552.9 4,413 100.0% 512.8 442.7 429.1,456.4 2000 4,287 100.0% 522.5 541.7 525.5,557.9 4,442 100.0% 515.0 446.3 432.6,460.0 2001 4,385 100.0% 531.9 544.0 527.9,560.1 4,314 100.0% 498.8 423.4 410.2,436.6 2002 4,586 100.0% 553.3 558.2 542.0,574.3 4,598 100.0% 529.9 442.4 429.1,455.8 2003 4,719 100.0% 566.6 563.4 547.3,579.5 4,726 100.0% 543.3 453.3 439.8,466.8 2004 4,643 100.0% 555.1 543.1 527.5,558.7 4,662 100.0% 533.5 443.1 429.8,456.3 2000-2004 22,620 100.0% 546.0 550.2 543.1,557.4 22,742 100.0% 524.2 441.7 435.7,447.7 1993-2004 51,820 100.0% 528.2 552.7 547.9,557.5 52,968 100.0% 514.8 443.1 439.1,447.0
All cancers excluding non-melanoma skin cancer (C00-C97, ex. C44) Male Female Year of %cancer Crude EASR 95% %cancer Crude EASR 95% diagnosis Cases EASR Cases EASR cases rate CI cases rate CI 1993 3,128 75.9% 391.9 430.7 415.5,445.9 3,192 74.6% 381.2 345.4 332.9,358.0 1994 3,109 74.7% 387.7 424.5 409.5,439.4 3,118 75.1% 370.4 337.6 325.1,350.0 1995 3,058 75.0% 380.3 412.1 397.5,426.8 3,171 75.4% 375.2 341.0 328.5,353.4 1996 3,157 74.5% 389.6 417.9 403.2,432.5 3,258 73.7% 382.7 342.5 330.2,354.8 1997 3,039 73.0% 372.6 398.3 384.1,412.5 3,289 75.3% 384.3 340.2 328.0,352.3 1998 3,126 73.8% 381.8 403.8 389.6,418.0 3,323 75.6% 386.8 345.5 333.2,357.8 1999 3,010 71.6% 367.7 385.0 371.2,398.7 3,344 75.8% 388.6 342.6 330.5,354.7 2000 3,121 72.8% 380.4 394.1 380.3,408.0 3,397 76.5% 393.9 350.2 337.9,362.4 2001 3,257 74.3% 395.1 404.0 390.1,417.9 3,282 76.1% 379.5 329.9 318.1,341.7 2002 3,297 71.9% 397.8 401.9 388.2,415.7 3,507 76.3% 404.1 347.2 335.2,359.2 2003 3,426 72.6% 411.4 409.2 395.5,423.0 3,602 76.2% 414.1 355.4 343.3,367.4 2004 3,427 73.8% 409.7 401.2 387.8,414.7 3,595 77.1% 411.4 351.8 339.9,363.8 2000-2004 16,528 73.1% 398.9 402.2 396.1,408.4 17,383 76.4% 400.6 346.9 341.5,352.3 1993-2004 38,155 73.6% 388.9 406.6 402.5,410.7 40,078 75.7% 389.5 344.2 340.7,347.7
Cancer of the lip, oral cavity & pharynx (C00-C14) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 107 2.6% 13.4 15.2 12.3,18.1 54 1.3% 6.4 5.3 3.8,6.8 1994 108 2.6% 13.5 14.8 12.0,17.7 47 1.1% 5.6 4.7 3.3,6.2 1995 101 2.5% 12.6 14.4 11.6,17.3 51 1.2% 6.0 5.8 4.1,7.4 1996 103 2.4% 12.7 14.1 11.4,16.9 50 1.1% 5.9 5.0 3.6,6.5 1997 104 2.5% 12.8 14.3 11.6,17.1 45 1.0% 5.3 4.5 3.1,5.9 1998 83 2.0% 10.1 11.0 8.6,13.4 42 1.0% 4.9 4.1 2.8,5.4 1999 91 2.2% 11.1 12.1 9.6,14.5 56 1.3% 6.5 5.8 4.2,7.4 2000 85 2.0% 10.4 11.1 8.7,13.5 42 0.9% 4.9 4.5 3.0,5.9 2001 88 2.0% 10.7 11.4 9.0,13.8 40 0.9% 4.6 3.8 2.6,5.1 2002 86 1.9% 10.4 10.8 8.5,13.1 43 0.9% 5.0 4.1 2.8,5.4 2003 84 1.8% 10.1 10.1 7.9,12.2 48 1.0% 5.5 5.0 3.5,6.4 2004 105 2.3% 12.6 12.9 10.4,15.4 48 1.0% 5.5 4.8 3.4,6.2 2000-2004 448 2.0% 10.8 11.3 10.2,12.3 221 1.0% 5.1 4.4 3.8,5.0 1993-2004 1,145 2.2% 11.7 12.6 11.9,13.4 566 1.1% 5.5 4.8 4.4,5.2
Oesophageal cancer (C15) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 89 2.2% 11.1 12.3 9.7,14.9 56 1.3% 6.7 5.3 3.8,6.7 1994 100 2.4% 12.5 14.0 11.2,16.8 52 1.3% 6.2 4.6 3.3,5.9 1995 95 2.3% 11.8 13.4 10.7,16.1 54 1.3% 6.4 4.9 3.5,6.3 1996 78 1.8% 9.6 10.2 7.9,12.5 60 1.4% 7.0 5.3 3.9,6.7 1997 97 2.3% 11.9 13.3 10.6,16.0 74 1.7% 8.6 6.3 4.8,7.8 1998 100 2.4% 12.2 13.5 10.8,16.1 53 1.2% 6.2 4.4 3.1,5.7 1999 92 2.2% 11.2 12.0 9.5,14.5 61 1.4% 7.1 5.6 4.1,7.1 2000 69 1.6% 8.4 8.8 6.7,11.0 69 1.6% 8.0 6.2 4.6,7.7 2001 101 2.3% 12.3 12.8 10.3,15.3 64 1.5% 7.4 5.5 4.1,7.0 2002 86 1.9% 10.4 10.8 8.5,13.1 58 1.3% 6.7 4.9 3.6,6.2 2003 97 2.1% 11.6 11.6 9.3,13.9 53 1.1% 6.1 4.5 3.3,5.8 2004 106 2.3% 12.7 12.6 10.2,15.1 49 1.1% 5.6 3.7 2.6,4.8 2000-2004 459 2.0% 11.1 11.4 10.3,12.4 293 1.3% 6.8 5.0 4.4,5.6 1993-2004 1,110 2.1% 11.3 12.1 11.4,12.8 703 1.3% 6.8 5.1 4.7,5.5 EASR: European age-standardised rate
142
Incidence rates by sex and cancer site
Stomach cancer (C16) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 153 3.7% 19.2 21.2 17.8,24.6 105 2.5% 12.5 9.5 7.6,11.5 1994 167 4.0% 20.8 22.5 19.0,26.0 97 2.3% 11.5 9.0 7.1,10.9 1995 155 3.8% 19.3 21.3 17.9,24.7 85 2.0% 10.1 8.2 6.4,10.1 1996 171 4.0% 21.1 23.0 19.5,26.5 117 2.6% 13.7 10.6 8.6,12.7 1997 143 3.4% 17.5 18.9 15.8,22.1 99 2.3% 11.6 8.7 6.9,10.5 1998 175 4.1% 21.4 23.1 19.6,26.5 100 2.3% 11.6 9.0 7.1,10.8 1999 157 3.7% 19.2 19.9 16.7,23.0 107 2.4% 12.4 9.4 7.6,11.3 2000 140 3.3% 17.1 17.7 14.8,20.7 94 2.1% 10.9 8.4 6.6,10.2 2001 148 3.4% 18.0 17.7 14.8,20.6 107 2.5% 12.4 8.6 6.9,10.3 2002 158 3.4% 19.1 18.9 15.9,21.9 100 2.2% 11.5 8.5 6.7,10.3 2003 171 3.6% 20.5 20.4 17.4,23.5 92 1.9% 10.6 7.7 6.0,9.4 2004 123 2.6% 14.7 14.2 11.7,16.8 80 1.7% 9.2 6.4 4.9,7.9 2000-2004 740 3.3% 17.9 17.8 16.5,19.1 473 2.1% 10.9 7.9 7.2,8.7 1993-2004 1,861 3.6% 19.0 19.8 18.9,20.7 1,183 2.2% 11.5 8.6 8.1,9.2
Colorectal cancer (C18-C21) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 475 11.5% 59.5 66.3 60.3,72.4 450 10.5% 53.7 44.4 40.1,48.8 1994 482 11.6% 60.1 66.1 60.1,72.0 435 10.5% 51.7 43.1 38.8,47.4 1995 491 12.0% 61.1 66.6 60.7,72.6 497 11.8% 58.8 48.1 43.6,52.6 1996 503 11.9% 62.1 67.4 61.5,73.4 467 10.6% 54.9 44.6 40.3,48.9 1997 455 10.9% 55.8 59.4 53.9,64.9 455 10.4% 53.2 42.1 38.0,46.2 1998 491 11.6% 60.0 64.0 58.2,69.7 441 10.0% 51.3 43.4 39.1,47.6 1999 449 10.7% 54.9 57.5 52.2,62.9 456 10.3% 53.0 41.8 37.7,45.8 2000 461 10.8% 56.2 58.4 53.1,63.8 422 9.5% 48.9 40.2 36.2,44.3 2001 528 12.0% 64.0 65.6 59.9,71.2 426 9.9% 49.3 39.4 35.5,43.4 2002 466 10.2% 56.2 57.2 51.9,62.4 450 9.8% 51.9 41.5 37.5,45.6 2003 559 11.8% 67.1 66.5 61.0,72.1 452 9.6% 52.0 39.8 35.9,43.7 2004 507 10.9% 60.6 59.5 54.3,64.8 447 9.6% 51.2 40.4 36.5,44.4 2000-2004 2,521 11.1% 60.8 61.5 59.0,63.9 2,197 9.7% 50.6 40.3 38.5,42.0 1993-2004 5,867 11.3% 59.8 62.8 61.2,64.4 5,398 10.2% 52.5 42.3 41.1,43.5
Cancer of the colon (C18) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 290 7.0% 36.3 40.5 35.8,45.2 321 7.5% 38.3 31.4 27.7,35.0 1994 305 7.3% 38.0 42.0 37.2,46.7 313 7.5% 37.2 31.2 27.6,34.9 1995 316 7.8% 39.3 42.8 38.0,47.6 349 8.3% 41.3 33.6 29.8,37.3 1996 315 7.4% 38.9 42.6 37.9,47.4 310 7.0% 36.4 29.6 26.1,33.1 1997 298 7.2% 36.5 38.7 34.2,43.1 311 7.1% 36.3 28.4 25.1,31.8 1998 304 7.2% 37.1 39.7 35.2,44.2 324 7.4% 37.7 31.6 28.0,35.2 1999 289 6.9% 35.3 37.3 32.9,41.6 334 7.6% 38.8 30.3 26.8,33.7 2000 275 6.4% 33.5 34.7 30.6,38.8 270 6.1% 31.3 25.4 22.2,28.6 2001 315 7.2% 38.2 39.0 34.6,43.3 271 6.3% 31.3 24.1 21.1,27.1 2002 300 6.5% 36.2 36.8 32.6,41.0 317 6.9% 36.5 28.7 25.4,32.1 2003 313 6.6% 37.6 36.9 32.8,41.0 310 6.6% 35.6 27.4 24.2,30.6 2004 300 6.5% 35.9 34.9 30.9,38.9 298 6.4% 34.1 26.6 23.4,29.7 2000-2004 1,503 6.6% 36.3 36.4 34.6,38.3 1,466 6.4% 33.8 26.5 25.0,27.9 1993-2004 3,620 7.0% 36.9 38.7 37.4,39.9 3,728 7.0% 36.2 28.9 27.9,29.9
Cancer of the rectum, rectosigmoid junction & anus (C19-C21) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 185 4.5% 23.2 25.8 22.1,29.6 129 3.0% 15.4 13.0 10.6,15.4 1994 177 4.3% 22.1 24.1 20.5,27.7 122 2.9% 14.5 11.9 9.6,14.1 1995 175 4.3% 21.8 23.8 20.3,27.4 148 3.5% 17.5 14.5 12.1,17.0 1996 188 4.4% 23.2 24.8 21.2,28.4 157 3.6% 18.4 15.0 12.5,17.5 1997 157 3.8% 19.3 20.7 17.5,24.0 144 3.3% 16.8 13.7 11.3,16.0 1998 187 4.4% 22.8 24.3 20.8,27.8 117 2.7% 13.6 11.8 9.5,14.0 1999 160 3.8% 19.5 20.3 17.1,23.4 122 2.8% 14.2 11.5 9.4,13.7 2000 186 4.3% 22.7 23.7 20.3,27.2 152 3.4% 17.6 14.8 12.3,17.3 2001 213 4.9% 25.8 26.6 23.0,30.2 155 3.6% 17.9 15.3 12.8,17.8 2002 166 3.6% 20.0 20.4 17.3,23.5 133 2.9% 15.3 12.8 10.5,15.1 2003 246 5.2% 29.5 29.6 25.9,33.4 142 3.0% 16.3 12.4 10.2,14.6 2004 207 4.5% 24.7 24.6 21.3,28.0 149 3.2% 17.1 13.9 11.5,16.2 2000-2004 1,018 4.5% 24.6 25.0 23.5,26.6 731 3.2% 16.8 13.8 12.8,14.9 1993-2004 2,247 4.3% 22.9 24.1 23.1,25.1 1,670 3.2% 16.2 13.4 12.7,14.0 EASR: European age-standardised rate
Northern Ireland Cancer Registry 143
Survival of cancer patients in Northern Ireland: 1993-2004
Liver cancer (C22) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 32 0.8% 4.0 4.5 2.9,6.0 33 0.8% 3.9 3.2 2.0,4.3 1994 26 0.6% 3.2 3.7 2.2,5.1 29 0.7% 3.4 2.7 1.6,3.7 1995 32 0.8% 4.0 4.4 2.9,6.0 17 0.4% 2.0 1.7 0.9,2.6 1996 33 0.8% 4.1 4.4 2.9,6.0 30 0.7% 3.5 2.6 1.6,3.6 1997 31 0.7% 3.8 3.8 2.5,5.2 27 0.6% 3.2 2.1 1.2,3.0 1998 26 0.6% 3.2 3.3 2.0,4.6 20 0.5% 2.3 2.0 1.1,3.0 1999 20 0.5% 2.4 2.8 1.6,4.0 32 0.7% 3.7 2.6 1.7,3.5 2000 34 0.8% 4.1 4.2 2.8,5.6 30 0.7% 3.5 2.9 1.8,3.9 2001 17 0.4% 2.1 2.2 1.1,3.2 8 0.2% 0.9 0.9 0.3,1.5 2002 39 0.9% 4.7 4.7 3.2,6.2 26 0.6% 3.0 2.5 1.5,3.5 2003 35 0.7% 4.2 4.2 2.8,5.6 19 0.4% 2.2 1.6 0.9,2.4 2004 30 0.6% 3.6 3.6 2.3,4.9 16 0.3% 1.8 1.4 0.7,2.1 2000-2004 155 0.7% 3.7 3.8 3.2,4.4 99 0.4% 2.3 1.8 1.5,2.2 1993-2004 355 0.7% 3.6 3.8 3.4,4.2 287 0.5% 2.8 2.2 1.9,2.4
Pancreatic cancer (C25) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 90 2.2% 11.3 12.1 9.6,14.6 85 2.0% 10.2 7.9 6.1,9.7 1994 62 1.5% 7.7 8.5 6.4,10.7 78 1.9% 9.3 7.5 5.8,9.3 1995 58 1.4% 7.2 7.7 5.7,9.7 66 1.6% 7.8 6.1 4.5,7.6 1996 91 2.1% 11.2 11.8 9.3,14.2 72 1.6% 8.5 6.6 5.0,8.2 1997 80 1.9% 9.8 10.5 8.2,12.9 82 1.9% 9.6 7.2 5.5,8.8 1998 71 1.7% 8.7 9.3 7.1,11.5 65 1.5% 7.6 5.6 4.2,7.0 1999 63 1.5% 7.7 8.2 6.2,10.3 59 1.3% 6.9 5.1 3.7,6.4 2000 65 1.5% 7.9 8.3 6.3,10.4 81 1.8% 9.4 7.7 6.0,9.5 2001 96 2.2% 11.6 12.0 9.6,14.5 75 1.7% 8.7 6.2 4.7,7.7 2002 84 1.8% 10.1 9.9 7.8,12.1 86 1.9% 9.9 7.4 5.8,9.1 2003 63 1.3% 7.6 7.3 5.5,9.1 97 2.1% 11.2 8.0 6.3,9.7 2004 71 1.5% 8.5 8.5 6.5,10.5 82 1.8% 9.4 7.1 5.5,8.7 2000-2004 379 1.7% 9.1 9.2 8.3,10.1 421 1.9% 9.7 7.3 6.6,8.0 1993-2004 894 1.7% 9.1 9.5 8.9,10.1 928 1.8% 9.0 6.9 6.4,7.3
Cancer of the larynx (C32) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 59 1.4% 7.4 8.6 6.4,10.8 18 0.4% 2.1 2.1 1.1,3.1 1994 48 1.2% 6.0 6.7 4.8,8.7 9 0.2% 1.1 0.9 0.3,1.6 1995 58 1.4% 7.2 8.3 6.1,10.4 15 0.4% 1.8 1.4 0.7,2.2 1996 50 1.2% 6.2 7.1 5.1,9.0 11 0.2% 1.3 1.1 0.5,1.8 1997 53 1.3% 6.5 7.3 5.3,9.3 11 0.3% 1.3 1.4 0.6,2.2 1998 51 1.2% 6.2 6.9 5.0,8.8 14 0.3% 1.6 1.5 0.7,2.3 1999 65 1.5% 7.9 8.8 6.6,10.9 14 0.3% 1.6 1.5 0.7,2.3 2000 46 1.1% 5.6 6.0 4.3,7.8 14 0.3% 1.6 1.7 0.8,2.6 2001 51 1.2% 6.2 6.4 4.7,8.2 13 0.3% 1.5 1.6 0.7,2.5 2002 55 1.2% 6.6 6.9 5.0,8.7 9 0.2% 1.0 1.0 0.3,1.7 2003 49 1.0% 5.9 6.1 4.4,7.8 13 0.3% 1.5 1.3 0.6,2.1 2004 40 0.9% 4.8 4.9 3.3,6.4 13 0.3% 1.5 1.4 0.6,2.2 2000-2004 241 1.1% 5.8 6.1 5.3,6.8 62 0.3% 1.4 1.4 1.0,1.8 1993-2004 625 1.2% 6.4 7.0 6.4,7.5 154 0.3% 1.5 1.4 1.2,1.7
Lung cancer (C33-C34) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 565 13.7% 70.8 77.9 71.4,84.4 319 7.5% 38.1 34.4 30.5,38.4 1994 625 15.0% 77.9 87.5 80.6,94.4 311 7.5% 36.9 32.6 28.8,36.4 1995 546 13.4% 67.9 73.2 67.0,79.4 331 7.9% 39.2 34.2 30.3,38.1 1996 551 13.0% 68.0 72.7 66.6,78.9 308 7.0% 36.2 32.2 28.5,36.0 1997 557 13.4% 68.3 73.4 67.3,79.6 325 7.4% 38.0 32.1 28.5,35.8 1998 565 13.3% 69.0 72.1 66.1,78.1 330 7.5% 38.4 32.0 28.4,35.6 1999 512 12.2% 62.6 65.1 59.4,70.8 358 8.1% 41.6 35.2 31.4,39.0 2000 519 12.1% 63.3 65.7 60.0,71.4 341 7.7% 39.5 34.2 30.4,38.0 2001 572 13.0% 69.4 70.6 64.7,76.4 321 7.4% 37.1 31.3 27.7,34.8 2002 505 11.0% 60.9 61.2 55.8,66.6 363 7.9% 41.8 34.1 30.4,37.7 2003 530 11.2% 63.6 62.7 57.3,68.1 362 7.7% 41.6 34.3 30.6,38.0 2004 571 12.3% 68.3 65.6 60.2,71.0 361 7.7% 41.3 32.9 29.4,36.5 2000-2004 2,697 11.9% 65.1 65.1 62.6,67.6 1,748 7.7% 40.3 33.4 31.7,35.0 1993-2004 6,618 12.8% 67.5 70.4 68.7,72.1 4,030 7.6% 39.2 33.3 32.2,34.4 EASR: European age-standardised rate
144
Incidence rates by sex and cancer site
Bone cancer (C40-C41) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 6 0.1% 0.8 0.9 0.2,1.6 6 0.1% 0.7 0.6 0.1,1.1 1994 8 0.2% 1.0 0.9 0.3,1.5 6 0.1% 0.7 0.6 0.1,1.1 1995 15 0.4% 1.9 1.8 0.9,2.7 10 0.2% 1.2 1.0 0.4,1.7 1996 11 0.3% 1.4 1.3 0.5,2.0 <5 1997 9 0.2% 1.1 1.1 0.4,1.9 5 0.1% 0.6 0.6 0.1,1.2 1998 6 0.1% 0.7 0.7 0.1,1.2 <5 1999 6 0.1% 0.7 0.8 0.1,1.4 6 0.1% 0.7 0.6 0.1,1.1 2000 8 0.2% 1.0 1.0 0.3,1.7 <5 2001 <5 <5 2002 <5 6 0.1% 0.7 0.6 0.1,1.1 2003 8 0.2% 1.0 1.0 0.3,1.7 <5 2004 7 0.2% 0.8 0.8 0.2,1.4 10 0.2% 1.1 1.0 0.4,1.6 2000-2004 29 0.1% 0.7 0.7 0.5,1.0 25 0.1% 0.6 0.5 0.3,0.7 1993-2004 90 0.2% 0.9 0.9 0.7,1.1 63 0.1% 0.6 0.6 0.4,0.7
Malignant melanoma (C43) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 58 1.4% 7.3 8.3 6.2,10.5 126 2.9% 15.0 14.2 11.7,16.8 1994 68 1.6% 8.5 9.2 7.0,11.5 111 2.7% 13.2 12.8 10.3,15.3 1995 68 1.7% 8.5 9.3 7.1,11.6 101 2.4% 12.0 11.4 9.1,13.8 1996 70 1.7% 8.6 9.5 7.3,11.8 105 2.4% 12.3 12.0 9.6,14.3 1997 66 1.6% 8.1 8.8 6.6,10.9 93 2.1% 10.9 10.5 8.3,12.7 1998 61 1.4% 7.5 8.0 6.0,10.0 116 2.6% 13.5 12.2 9.9,14.5 1999 69 1.6% 8.4 8.7 6.6,10.8 109 2.5% 12.7 12.1 9.8,14.5 2000 76 1.8% 9.3 9.9 7.6,12.1 111 2.5% 12.9 12.0 9.7,14.3 2001 87 2.0% 10.6 10.9 8.6,13.2 129 3.0% 14.9 13.5 11.1,15.9 2002 101 2.2% 12.2 12.5 10.0,14.9 146 3.2% 16.8 15.6 13.0,18.2 2003 83 1.8% 10.0 10.3 8.1,12.5 129 2.7% 14.8 13.3 10.9,15.6 2004 112 2.4% 13.4 13.3 10.8,15.8 148 3.2% 16.9 15.8 13.2,18.4 2000-2004 459 2.0% 11.1 11.4 10.3,12.4 663 2.9% 15.3 14.1 13.0,15.2 1993-2004 919 1.8% 9.4 9.9 9.3,10.6 1,424 2.7% 13.8 13.0 12.3,13.7
Non-melanoma skin cancer (C44) Male Female Year of %cancer Crude EASR 95% %cancer Crude EASR 95% diagnosis Cases EASR Cases EASR cases rate CI cases rate CI 1993 995 24.1% 124.7 138.7 130.0,147.4 1,084 25.4% 129.5 105.9 99.2,112.6 1994 1,054 25.3% 131.4 144.9 136.0,153.7 1,035 24.9% 123.0 100.9 94.4,107.4 1995 1,019 25.0% 126.7 139.4 130.7,148.1 1,034 24.6% 122.3 98.6 92.2,105.0 1996 1,081 25.5% 133.4 144.6 135.9,153.3 1,161 26.3% 136.4 109.3 102.6,116.0 1997 1,125 27.0% 137.9 148.5 139.8,157.3 1,077 24.7% 125.9 100.2 93.9,106.5 1998 1,108 26.2% 135.3 144.4 135.8,152.9 1,071 24.4% 124.7 99.3 93.0,105.6 1999 1,191 28.4% 145.5 151.7 143.0,160.4 1,069 24.2% 124.2 100.1 93.8,106.5 2000 1,166 27.2% 142.1 147.6 139.1,156.1 1,045 23.5% 121.2 96.1 90.0,102.3 2001 1,128 25.7% 136.8 140.0 131.8,148.3 1,032 23.9% 119.3 93.5 87.5,99.5 2002 1,289 28.1% 155.5 156.3 147.6,164.9 1,091 23.7% 125.7 95.3 89.3,101.2 2003 1,293 27.4% 155.3 154.2 145.7,162.7 1,124 23.8% 129.2 97.9 91.9,104.0 2004 1,216 26.2% 145.4 141.9 133.8,149.9 1,067 22.9% 122.1 91.3 85.5,97.1 2000-2004 6,092 26.9% 147.0 148.0 144.3,151.8 5,359 23.6% 123.5 94.8 92.1,97.5 1993-2004 13,665 26.4% 139.3 146.1 143.7,148.6 12,890 24.3% 125.3 98.9 97.1,100.7
Mesothelioma (C45) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 34 0.8% 4.3 4.5 3.0,6.1 1994 30 0.7% 3.7 4.2 2.7,5.8 1995 28 0.7% 3.5 3.9 2.4,5.4 1996 36 0.8% 4.4 4.7 3.2,6.3 1997 35 0.8% 4.3 4.8 3.2,6.5 1998 45 1.1% 5.5 5.8 4.1,7.6 1999 60 1.4% 7.3 7.7 5.7,9.7 2000 40 0.9% 4.9 5.0 3.4,6.5 2001 53 1.2% 6.4 6.5 4.7,8.2 2002 51 1.1% 6.2 6.2 4.5,7.9 2003 36 0.8% 4.3 4.4 2.9,5.9 2004 41 0.9% 4.9 4.8 3.3,6.3 2000-2004 221 1.0% 5.3 5.4 4.7,6.1 26 0.1% 0.6 0.5 0.3,0.7 1993-2004 489 0.9% 5.0 5.2 4.8,5.7 56 0.1% 0.5 0.5 0.4,0.6 EASR: European age-standardised rate
Northern Ireland Cancer Registry 145
Survival of cancer patients in Northern Ireland: 1993-2004
Breast cancer (C50) Male Female Year of %cancer Crude EASR %cancer Crude EASR 95% diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate CI 1993 771 18.0% 92.1 93.0 86.2,99.9 1994 833 20.1% 99.0 100.8 93.7,107.9 1995 880 20.9% 104.1 104.2 97.1,111.4 1996 847 19.2% 99.5 99.5 92.5,106.5 1997 857 19.6% 100.1 99.6 92.7,106.5 1998 911 20.7% 106.0 104.7 97.7,111.7 1999 946 21.4% 109.9 105.8 98.8,112.8 2000 961 21.6% 111.4 107.5 100.5,114.5 2001 922 21.4% 106.6 103.3 96.4,110.1 2002 945 20.6% 108.9 102.0 95.3,108.7 2003 1,035 21.9% 119.0 112.2 105.2,119.3 2004 1,117 24.0% 127.8 117.7 110.6,124.8 2000-2004 33 0.1% 0.8 0.8 0.5,1.1 4,980 21.9% 114.8 108.6 105.5,111.7 1993-2004 79 0.2% 0.8 0.8 0.7,1.0 11,025 20.8% 107.1 104.4 102.4,106.4
Cervical cancer (C53) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 84 2.0% 10.0 10.5 8.2,12.8 1994 75 1.8% 8.9 9.2 7.1,11.3 1995 86 2.0% 10.2 11.0 8.6,13.3 1996 93 2.1% 10.9 11.3 8.9,13.6 1997 84 1.9% 9.8 9.8 7.6,11.9 1998 80 1.8% 9.3 9.3 7.2,11.3 1999 76 1.7% 8.8 8.9 6.8,10.9 2000 94 2.1% 10.9 10.7 8.5,12.9 2001 72 1.7% 8.3 8.2 6.3,10.1 2002 82 1.8% 9.4 9.3 7.2,11.3 2003 75 1.6% 8.6 8.4 6.5,10.3 2004 67 1.4% 7.7 7.2 5.5,9.0 2000-2004 390 1.7% 9.0 8.7 7.9,9.6 1993-2004 968 1.8% 9.4 9.4 8.8,10.0
Cancer of the uterus (C54) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 89 2.1% 10.6 10.4 8.2,12.7 1994 105 2.5% 12.5 11.8 9.5,14.2 1995 90 2.1% 10.6 10.3 8.1,12.6 1996 98 2.2% 11.5 11.2 8.9,13.5 1997 116 2.7% 13.6 13.5 10.9,16.0 1998 105 2.4% 12.2 11.7 9.4,14.0 1999 119 2.7% 13.8 13.4 10.9,15.9 2000 144 3.2% 16.7 16.0 13.3,18.7 2001 143 3.3% 16.5 15.6 13.0,18.3 2002 158 3.4% 18.2 17.1 14.3,19.8 2003 176 3.7% 20.2 18.9 16.0,21.7 2004 156 3.3% 17.9 16.0 13.4,18.6 2000-2004 777 3.4% 17.9 16.7 15.5,17.9 1993-2004 1,499 2.8% 14.6 13.9 13.2,14.6
Ovarian cancer (C56) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 151 3.5% 18.0 17.9 14.9,20.9 1994 155 3.7% 18.4 18.2 15.2,21.2 1995 156 3.7% 18.5 18.3 15.4,21.3 1996 151 3.4% 17.7 17.2 14.4,20.1 1997 185 4.2% 21.6 20.9 17.8,24.1 1998 195 4.4% 22.7 22.0 18.8,25.1 1999 183 4.1% 21.3 21.4 18.2,24.6 2000 168 3.8% 19.5 18.5 15.6,21.4 2001 177 4.1% 20.5 19.1 16.2,22.0 2002 191 4.2% 22.0 19.9 17.0,22.9 2003 214 4.5% 24.6 22.0 18.9,25.1 2004 205 4.4% 23.5 21.0 18.0,24.0 2000-2004 955 4.2% 22.0 20.1 18.8,21.5 1993-2004 2,131 4.0% 20.7 19.7 18.9,20.6 EASR: European age-standardised rate
146
Incidence rates by sex and cancer site
Prostate cancer (C61) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 474 11.5% 59.4 64.0 58.2,69.9 1994 484 11.6% 60.4 64.2 58.4,70.0 1995 511 12.5% 63.6 67.1 61.2,73.1 1996 456 10.8% 56.3 59.5 54.0,65.0 1997 491 11.8% 60.2 63.0 57.4,68.6 1998 497 11.7% 60.7 63.0 57.4,68.6 1999 494 11.8% 60.4 62.4 56.9,68.0 2000 576 13.4% 70.2 71.6 65.7,77.5 2001 554 12.6% 67.2 68.5 62.7,74.2 2002 652 14.2% 78.7 79.2 73.1,85.3 2003 739 15.7% 88.7 88.1 81.7,94.5 2004 757 16.3% 90.5 88.6 82.3,95.0 2000-2004 3,278 14.5% 79.1 79.4 76.7,82.1 1993-2004 6,685 12.9% 68.1 70.3 68.6,72.0
Testicular cancer (C62) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 55 1.3% 6.9 6.9 5.0,8.7 1994 47 1.1% 5.9 5.8 4.1,7.4 1995 40 1.0% 5.0 4.9 3.3,6.4 1996 56 1.3% 6.9 6.8 5.0,8.6 1997 48 1.2% 5.9 5.8 4.2,7.5 1998 46 1.1% 5.6 5.6 3.9,7.2 1999 56 1.3% 6.8 6.9 5.1,8.7 2000 68 1.6% 8.3 8.0 6.1,10.0 2001 51 1.2% 6.2 6.1 4.4,7.8 2002 56 1.2% 6.8 6.7 5.0,8.5 2003 56 1.2% 6.7 6.7 4.9,8.5 2004 69 1.5% 8.2 8.1 6.2,10.1 2000-2004 300 1.3% 7.2 7.2 6.3,8.0 1993-2004 648 1.3% 6.6 6.6 6.0,7.1
Cancer of the kidney (C64-C66, C68) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 95 2.3% 11.9 13.2 10.5,15.8 70 1.6% 8.4 7.9 6.0,9.9 1994 113 2.7% 14.1 15.5 12.6,18.4 47 1.1% 5.6 5.0 3.5,6.5 1995 96 2.4% 11.9 13.2 10.5,15.9 67 1.6% 7.9 7.5 5.6,9.4 1996 95 2.2% 11.7 13.1 10.5,15.8 63 1.4% 7.4 6.5 4.8,8.1 1997 99 2.4% 12.1 13.1 10.5,15.7 72 1.6% 8.4 7.6 5.8,9.5 1998 98 2.3% 12.0 12.8 10.2,15.3 76 1.7% 8.8 7.3 5.6,9.0 1999 101 2.4% 12.3 13.3 10.7,15.9 58 1.3% 6.7 6.1 4.5,7.8 2000 92 2.1% 11.2 11.8 9.3,14.2 69 1.6% 8.0 7.1 5.3,8.8 2001 105 2.4% 12.7 13.6 11.0,16.2 64 1.5% 7.4 6.5 4.8,8.1 2002 115 2.5% 13.9 14.1 11.5,16.7 66 1.4% 7.6 6.5 4.8,8.2 2003 128 2.7% 15.4 15.5 12.8,18.2 78 1.7% 9.0 7.7 5.9,9.5 2004 108 2.3% 12.9 12.6 10.2,15.0 79 1.7% 9.0 7.6 5.8,9.3 2000-2004 548 2.4% 13.2 13.5 12.4,14.6 356 1.6% 8.2 7.1 6.3,7.8 1993-2004 1,245 2.4% 12.7 13.5 12.8,14.3 809 1.5% 7.9 6.9 6.4,7.4
Cancer of the bladder (C67) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 156 3.8% 19.5 21.6 18.1,25.0 51 1.2% 6.1 4.7 3.3,6.0 1994 138 3.3% 17.2 19.0 15.8,22.2 57 1.4% 6.8 4.7 3.4,6.0 1995 143 3.5% 17.8 19.0 15.8,22.1 66 1.6% 7.8 6.4 4.8,8.0 1996 176 4.2% 21.7 23.0 19.6,26.4 84 1.9% 9.9 7.7 6.0,9.5 1997 120 2.9% 14.7 15.7 12.9,18.6 43 1.0% 5.0 3.9 2.7,5.1 1998 162 3.8% 19.8 20.9 17.7,24.2 72 1.6% 8.4 6.3 4.8,7.8 1999 156 3.7% 19.1 19.9 16.7,23.0 58 1.3% 6.7 5.0 3.6,6.3 2000 145 3.4% 17.7 18.3 15.3,21.3 65 1.5% 7.5 5.7 4.2,7.1 2001 126 2.9% 15.3 15.3 12.6,18.0 57 1.3% 6.6 5.0 3.6,6.3 2002 129 2.8% 15.6 15.7 12.9,18.4 42 0.9% 4.8 3.3 2.2,4.3 2003 167 3.5% 20.1 19.9 16.9,23.0 58 1.2% 6.7 4.9 3.6,6.2 2004 148 3.2% 17.7 16.7 14.0,19.5 62 1.3% 7.1 5.8 4.3,7.3 2000-2004 715 3.2% 17.3 17.2 15.9,18.5 284 1.2% 6.5 4.9 4.3,5.5 1993-2004 1,766 3.4% 18.0 18.7 17.8,19.6 715 1.3% 6.9 5.3 4.9,5.7 EASR: European age-standardised rate
Northern Ireland Cancer Registry 147
Survival of cancer patients in Northern Ireland: 1993-2004
Cancer of the brain (C71) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 61 1.5% 7.6 8.3 6.2,10.4 40 0.9% 4.8 4.9 3.4,6.5 1994 52 1.2% 6.5 7.1 5.1,9.0 59 1.4% 7.0 7.1 5.3,9.0 1995 54 1.3% 6.7 7.5 5.4,9.5 25 0.6% 3.0 2.7 1.6,3.8 1996 72 1.7% 8.9 9.5 7.3,11.7 43 1.0% 5.1 4.8 3.4,6.3 1997 57 1.4% 7.0 7.6 5.6,9.6 52 1.2% 6.1 5.9 4.2,7.5 1998 62 1.5% 7.6 8.1 6.1,10.2 66 1.5% 7.7 7.3 5.5,9.2 1999 55 1.3% 6.7 7.1 5.2,9.0 30 0.7% 3.5 3.4 2.2,4.7 2000 64 1.5% 7.8 8.1 6.1,10.0 46 1.0% 5.3 5.0 3.5,6.5 2001 68 1.6% 8.2 8.5 6.4,10.5 51 1.2% 5.9 5.6 4.1,7.2 2002 75 1.6% 9.0 9.0 7.0,11.1 49 1.1% 5.6 5.2 3.7,6.7 2003 67 1.4% 8.0 8.2 6.2,10.1 49 1.0% 5.6 5.6 4.0,7.2 2004 44 0.9% 5.3 5.3 3.8,6.9 45 1.0% 5.1 4.9 3.5,6.4 2000-2004 318 1.4% 7.7 7.8 6.9,8.7 240 1.1% 5.5 5.3 4.6,6.0 1993-2004 731 1.4% 7.5 7.8 7.3,8.4 555 1.0% 5.4 5.2 4.8,5.7
Hodgkin’s disease (C81) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 32 0.8% 4.0 4.1 2.7,5.5 17 0.4% 2.0 1.9 1.0,2.9 1994 22 0.5% 2.7 3.0 1.7,4.2 16 0.4% 1.9 1.9 0.9,2.8 1995 28 0.7% 3.5 3.7 2.3,5.1 15 0.4% 1.8 1.8 0.9,2.7 1996 20 0.5% 2.5 2.5 1.4,3.6 14 0.3% 1.6 1.6 0.8,2.5 1997 20 0.5% 2.5 2.6 1.5,3.8 11 0.3% 1.3 1.3 0.5,2.1 1998 11 0.3% 1.3 1.4 0.5,2.2 18 0.4% 2.1 1.9 1.0,2.9 1999 27 0.6% 3.3 3.2 2.0,4.4 13 0.3% 1.5 1.4 0.6,2.2 2000 25 0.6% 3.0 3.1 1.9,4.3 11 0.2% 1.3 1.3 0.5,2.1 2001 23 0.5% 2.8 2.7 1.6,3.8 17 0.4% 2.0 2.0 1.1,3.0 2002 10 0.2% 1.2 1.2 0.5,2.0 18 0.4% 2.1 2.1 1.1,3.0 2003 19 0.4% 2.3 2.2 1.2,3.2 18 0.4% 2.1 2.1 1.1,3.0 2004 23 0.5% 2.7 2.7 1.6,3.9 17 0.4% 1.9 1.9 1.0,2.9 2000-2004 100 0.4% 2.4 2.4 1.9,2.9 81 0.4% 1.9 1.9 1.5,2.3 1993-2004 260 0.5% 2.7 2.7 2.4,3.0 185 0.3% 1.8 1.8 1.5,2.1
Non-Hodgkin’s lymphoma (C82-C85, C96) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 136 3.3% 17.0 18.6 15.4,21.7 104 2.4% 12.4 11.3 9.0,13.6 1994 105 2.5% 13.1 14.5 11.7,17.3 116 2.8% 13.8 12.7 10.2,15.1 1995 121 3.0% 15.0 16.7 13.7,19.7 97 2.3% 11.5 10.0 7.9,12.1 1996 126 3.0% 15.5 16.7 13.7,19.6 122 2.8% 14.3 12.4 10.1,14.7 1997 127 3.0% 15.6 16.6 13.7,19.5 117 2.7% 13.7 11.8 9.5,14.0 1998 120 2.8% 14.7 15.9 13.0,18.7 143 3.3% 16.6 15.4 12.8,18.0 1999 113 2.7% 13.8 14.5 11.8,17.2 133 3.0% 15.5 13.2 10.8,15.5 2000 135 3.1% 16.5 17.2 14.2,20.1 135 3.0% 15.7 14.0 11.5,16.4 2001 113 2.6% 13.7 14.1 11.5,16.7 139 3.2% 16.1 13.5 11.2,15.9 2002 130 2.8% 15.7 16.3 13.5,19.1 125 2.7% 14.4 12.3 10.1,14.6 2003 135 2.9% 16.2 16.4 13.6,19.2 132 2.8% 15.2 12.4 10.2,14.6 2004 135 2.9% 16.1 16.0 13.2,18.7 147 3.2% 16.8 13.4 11.1,15.7 2000-2004 648 2.9% 15.6 16.0 14.8,17.3 678 3.0% 15.6 13.1 12.1,14.2 1993-2004 1,496 2.9% 15.2 16.1 15.3,16.9 1,510 2.9% 14.7 12.7 12.0,13.4
Multiple myeloma (C90) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 52 1.3% 6.5 7.3 5.3,9.3 48 1.1% 5.7 4.9 3.5,6.4 1994 47 1.1% 5.9 6.2 4.4,8.1 46 1.1% 5.5 4.5 3.1,5.9 1995 37 0.9% 4.6 5.0 3.4,6.6 38 0.9% 4.5 3.7 2.4,4.9 1996 51 1.2% 6.3 6.7 4.9,8.6 44 1.0% 5.2 4.3 3.0,5.7 1997 70 1.7% 8.6 9.4 7.2,11.6 59 1.4% 6.9 5.2 3.8,6.6 1998 51 1.2% 6.2 6.5 4.7,8.3 40 0.9% 4.7 3.7 2.5,4.9 1999 47 1.1% 5.7 6.1 4.3,7.8 38 0.9% 4.4 3.9 2.6,5.2 2000 52 1.2% 6.3 6.6 4.8,8.4 58 1.3% 6.7 5.1 3.7,6.5 2001 68 1.6% 8.2 8.5 6.4,10.5 49 1.1% 5.7 4.1 2.9,5.3 2002 60 1.3% 7.2 7.0 5.2,8.8 37 0.8% 4.3 3.4 2.2,4.5 2003 61 1.3% 7.3 7.1 5.3,8.9 43 0.9% 4.9 3.4 2.3,4.5 2004 58 1.2% 6.9 6.7 5.0,8.4 44 0.9% 5.0 4.2 2.9,5.5 2000-2004 299 1.3% 7.2 7.2 6.3,8.0 231 1.0% 5.3 4.0 3.5,4.6 1993-2004 654 1.3% 6.7 7.0 6.4,7.5 544 1.0% 5.3 4.2 3.8,4.6 EASR: European age-standardised rate
148
Incidence rates by sex and cancer site
Leukaemia (C91-C95) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 93 2.3% 11.7 12.4 9.8,14.9 65 1.5% 7.8 6.9 5.2,8.7 1994 103 2.5% 12.8 13.5 10.9,16.2 54 1.3% 6.4 5.6 4.0,7.1 1995 91 2.2% 11.3 11.9 9.4,14.3 75 1.8% 8.9 7.7 5.9,9.5 1996 75 1.8% 9.3 9.7 7.5,11.9 75 1.7% 8.8 8.0 6.1,9.9 1997 104 2.5% 12.8 13.3 10.7,15.9 89 2.0% 10.4 9.0 7.0,11.0 1998 101 2.4% 12.3 12.6 10.1,15.1 64 1.5% 7.4 6.6 4.9,8.3 1999 92 2.2% 11.2 11.7 9.3,14.1 56 1.3% 6.5 5.2 3.7,6.6 2000 99 2.3% 12.1 12.2 9.8,14.6 68 1.5% 7.9 6.6 5.0,8.2 2001 85 1.9% 10.3 10.6 8.3,12.9 58 1.3% 6.7 5.3 3.8,6.7 2002 100 2.2% 12.1 12.3 9.9,14.8 78 1.7% 9.0 7.2 5.5,8.9 2003 64 1.4% 7.7 7.8 5.9,9.7 58 1.2% 6.7 5.7 4.2,7.2 2004 87 1.9% 10.4 10.2 8.1,12.4 58 1.2% 6.6 5.8 4.3,7.4 2000-2004 435 1.9% 10.5 10.6 9.6,11.6 320 1.4% 7.4 6.1 5.4,6.8 1993-2004 1,094 2.1% 11.2 11.5 10.8,12.2 798 1.5% 7.8 6.6 6.1,7.1
Childhood cancer (Ages 0-14, C00-C97, ex. C44) Male Female Year of %cancer Crude EASR %cancer Crude EASR diagnosis Cases EASR Cases EASR cases rate 95% CI cases rate 95% CI 1993 27 0.7% 13.4 13.8 8.6,19.1 26 0.6% 13.5 14.1 8.7,19.5 1994 30 0.7% 15.0 15.6 10.0,21.2 25 0.6% 13.0 13.5 8.2,18.8 1995 28 0.7% 14.0 14.5 9.1,19.8 19 0.5% 10.0 10.4 5.7,15.1 1996 37 0.9% 18.6 18.8 12.7,24.8 24 0.5% 12.6 13.2 7.9,18.5 1997 32 0.8% 16.1 16.8 11.0,22.7 24 0.5% 12.7 13.0 7.8,18.2 1998 26 0.6% 13.2 13.4 8.2,18.6 19 0.4% 10.1 11.1 6.1,16.1 1999 26 0.6% 13.3 13.3 8.2,18.4 19 0.4% 10.2 10.6 5.8,15.4 2000 29 0.7% 15.0 15.3 9.7,20.9 13 0.3% 7.1 7.3 3.3,11.4 2001 21 0.5% 11.1 11.4 6.5,16.3 18 0.4% 10.0 10.1 5.4,14.8 2002 27 0.6% 14.4 15.3 9.5,21.1 21 0.5% 11.8 12.1 6.9,17.3 2003 24 0.5% 12.9 13.2 7.9,18.5 30 0.6% 17.1 18.1 11.5,24.6 2004 17 0.4% 9.3 9.3 4.9,13.8 21 0.5% 12.1 12.7 7.2,18.2 2000-2004 118 0.5% 12.6 12.9 10.6,15.3 103 0.5% 11.6 12.0 9.7,14.3 1993-2004 324 0.6% 13.9 14.3 12.7,15.8 259 0.5% 11.7 12.2 10.7,13.7 EASR: European age-standardised rate
Northern Ireland Cancer Registry 149
Survival of cancer patients in Northern Ireland: 1993-2004
A5: MORTALITY RATES BY SEX AND CANCER SITE (1993-2004)
All cancers including non-melanoma skin cancer (C00-C97) Male Female Year of %cancer Crude EASR 95% %cancer Crude EASR 95% death Deaths EASR Deaths EASR deaths rate CI deaths rate CI 1993 1,884 100.0% 236.0 259.8 248.0,271.7 1,745 100.0% 208.4 176.5 167.8,185.3 1994 1,858 100.0% 231.7 254.8 243.1,266.5 1,757 100.0% 208.7 172.7 164.1,181.2 1995 1,845 100.0% 229.5 247.6 236.2,259.0 1,648 100.0% 195.0 162.6 154.3,170.9 1996 1,849 100.0% 228.2 246.0 234.7,257.3 1,685 100.0% 197.9 160.6 152.5,168.7 1997 1,849 100.0% 226.7 241.3 230.2,252.3 1,746 100.0% 204.0 164.3 156.2,172.5 1998 1,927 100.0% 235.4 247.8 236.7,258.9 1,736 100.0% 202.1 161.4 153.4,169.4 1999 1,798 100.0% 219.7 228.5 217.9,239.1 1,749 100.0% 203.3 161.7 153.7,169.7 2000 1,764 100.0% 215.0 222.3 211.9,232.7 1,793 100.0% 207.9 167.4 159.3,175.6 2001 1,923 100.0% 233.3 236.0 225.3,246.6 1,749 100.0% 202.2 158.0 150.2,165.8 2002 1,905 100.0% 229.8 231.1 220.7,241.6 1,758 100.0% 202.6 154.9 147.3,162.6 2003 1,902 100.0% 228.4 225.4 215.2,235.6 1,839 100.0% 211.4 160.8 153.1,168.6 2004 1,935 100.0% 231.3 222.3 212.4,232.3 1,815 100.0% 207.7 155.5 148.0,163.1 2000-2004 9,429 100.0% 227.6 227.4 222.8,232.0 8,954 100.0% 206.4 159.3 155.8,162.8 1993-2004 22,439 100.0% 228.7 238.0 234.9,241.2 21,020 100.0% 204.3 162.8 160.5,165.1
All cancers excluding non-melanoma skin cancer (C00-C97, ex. C44) Male Female Year of %cancer Crude EASR 95% %cancer Crude EASR 95% death Deaths EASR Deaths EASR deaths rate CI deaths rate CI 1993 1,881 99.8% 235.7 259.4 247.6,271.3 1,737 99.5% 207.4 175.6 166.9,184.3 1994 1,849 99.5% 230.6 253.5 241.8,265.2 1,755 99.9% 208.5 172.5 164.0,181.1 1995 1,842 99.8% 229.1 247.2 235.8,258.6 1,644 99.8% 194.5 162.3 154.0,170.6 1996 1,840 99.5% 227.1 244.8 233.5,256.0 1,682 99.8% 197.6 160.4 152.3,168.5 1997 1,840 99.5% 225.6 240.2 229.2,251.3 1,742 99.8% 203.6 164.0 155.9,172.1 1998 1,920 99.6% 234.5 246.8 235.7,257.9 1,731 99.7% 201.5 161.0 153.0,169.0 1999 1,789 99.5% 218.6 227.3 216.7,237.9 1,746 99.8% 202.9 161.4 153.4,169.4 2000 1,757 99.6% 214.1 221.5 211.0,231.9 1,790 99.8% 207.5 167.3 159.1,175.4 2001 1,918 99.7% 232.6 235.3 224.7,245.9 1,734 99.1% 200.5 156.9 149.1,164.7 2002 1,898 99.6% 229.0 230.3 219.9,240.8 1,753 99.7% 202.0 154.7 147.0,162.3 2003 1,894 99.6% 227.4 224.4 214.3,234.6 1,829 99.5% 210.3 160.2 152.5,168.0 2004 1,926 99.5% 230.2 221.3 211.3,231.3 1,808 99.6% 206.9 155.1 147.6,162.7 2000-2004 9,393 99.6% 226.7 226.5 221.9,231.1 8,914 99.6% 205.4 158.8 155.3,162.3 1993-2004 22,354 99.6% 227.9 237.1 234.0,240.3 20,951 99.7% 203.6 162.4 160.1,164.7
Cancer of the lip, oral cavity & pharynx (C00-C14) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 1993 38 2.0% 4.8 5.4 3.6,7.1 9 0.5% 1.1 0.7 0.2,1.3 1994 29 1.6% 3.6 4.3 2.7,5.8 19 1.1% 2.3 1.6 0.8,2.4 1995 29 1.6% 3.6 4.0 2.5,5.5 17 1.0% 2.0 1.5 0.8,2.3 1996 35 1.9% 4.3 4.8 3.2,6.4 27 1.6% 3.2 2.5 1.5,3.6 1997 36 1.9% 4.4 5.0 3.4,6.6 22 1.3% 2.6 1.8 1.0,2.6 1998 36 1.9% 4.4 4.8 3.2,6.3 19 1.1% 2.2 1.8 1.0,2.7 1999 27 1.5% 3.3 3.6 2.2,4.9 30 1.7% 3.5 2.7 1.7,3.8 2000 27 1.5% 3.3 3.4 2.1,4.7 22 1.2% 2.6 2.4 1.3,3.4 2001 35 1.8% 4.2 4.5 3.0,6.0 20 1.1% 2.3 1.9 1.0,2.9 2002 38 2.0% 4.6 4.8 3.2,6.3 19 1.1% 2.2 1.7 0.9,2.6 2003 30 1.6% 3.6 3.6 2.3,4.9 11 0.6% 1.3 1.0 0.4,1.6 2004 27 1.4% 3.2 3.3 2.0,4.5 16 0.9% 1.8 1.4 0.7,2.2 2000-2004 157 1.7% 3.8 3.9 3.3,4.5 88 1.0% 2.0 1.7 1.3,2.1 1993-2004 387 1.7% 3.9 4.3 3.8,4.7 231 1.1% 2.2 1.8 1.5,2.0
Oesophageal cancer (C15) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 1993 76 4.0% 9.5 10.8 8.3,13.3 50 2.9% 6.0 4.4 3.1,5.7 1994 87 4.7% 10.8 12.0 9.4,14.5 59 3.4% 7.0 5.3 3.8,6.7 1995 72 3.9% 9.0 9.5 7.3,11.7 48 2.9% 5.7 4.2 2.9,5.4 1996 91 4.9% 11.2 12.4 9.8,15.0 52 3.1% 6.1 4.5 3.2,5.8 1997 92 5.0% 11.3 12.4 9.9,15.0 57 3.3% 6.7 4.8 3.5,6.1 1998 92 4.8% 11.2 12.1 9.6,14.6 60 3.5% 7.0 5.1 3.7,6.5 1999 98 5.5% 12.0 12.7 10.2,15.3 60 3.4% 7.0 5.1 3.7,6.5 2000 92 5.2% 11.2 11.7 9.3,14.1 64 3.6% 7.4 5.2 3.9,6.6 2001 90 4.7% 10.9 11.1 8.8,13.5 60 3.4% 6.9 5.3 3.9,6.7 2002 111 5.8% 13.4 13.5 11.0,16.1 54 3.1% 6.2 4.3 3.0,5.5 2003 103 5.4% 12.4 12.2 9.9,14.6 51 2.8% 5.9 4.2 2.9,5.4 2004 87 4.5% 10.4 10.3 8.1,12.5 49 2.7% 5.6 3.7 2.6,4.8 2000-2004 483 5.1% 11.7 11.8 10.7,12.8 278 3.1% 6.4 4.5 4.0,5.1 1993-2004 1,091 4.9% 11.1 11.7 11.0,12.4 664 3.2% 6.5 4.7 4.3,5.0 EASR: European age-standardised rate
150
Mortality rates by sex and cancer site
Stomach cancer (C16) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 1993 126 6.7% 15.8 17.2 14.1,20.2 67 3.8% 8.0 5.9 4.4,7.4 1994 129 6.9% 16.1 18.0 14.8,21.1 72 4.1% 8.6 6.5 4.9,8.1 1995 98 5.3% 12.2 13.2 10.6,15.9 73 4.4% 8.6 6.4 4.8,7.9 1996 111 6.0% 13.7 14.9 12.1,17.7 86 5.1% 10.1 7.7 5.9,9.4 1997 101 5.5% 12.4 13.3 10.7,16.0 68 3.9% 7.9 5.2 3.9,6.5 1998 119 6.2% 14.5 15.8 12.9,18.6 96 5.5% 11.2 8.0 6.3,9.7 1999 116 6.5% 14.2 14.7 12.0,17.4 76 4.3% 8.8 6.3 4.8,7.8 2000 112 6.3% 13.7 13.9 11.3,16.5 64 3.6% 7.4 5.9 4.4,7.4 2001 97 5.0% 11.8 11.8 9.4,14.2 77 4.4% 8.9 6.2 4.7,7.7 2002 86 4.5% 10.4 10.2 8.0,12.3 78 4.4% 9.0 6.2 4.7,7.6 2003 100 5.3% 12.0 11.5 9.2,13.8 65 3.5% 7.5 5.1 3.8,6.4 2004 109 5.6% 13.0 12.5 10.2,14.9 70 3.9% 8.0 5.3 4.0,6.6 2000-2004 504 5.3% 12.2 12.0 10.9,13.1 354 4.0% 8.2 5.7 5.1,6.4 1993-2004 1,304 5.8% 13.3 13.8 13.1,14.6 892 4.2% 8.7 6.2 5.8,6.6
Colorectal cancer (C18-C21) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 1993 238 12.6% 29.8 33.5 29.1,37.8 236 13.5% 28.2 21.1 18.2,23.9 1994 216 11.6% 26.9 29.9 25.9,33.9 225 12.8% 26.7 20.6 17.7,23.4 1995 236 12.8% 29.4 31.9 27.8,36.1 219 13.3% 25.9 19.9 17.1,22.7 1996 214 11.6% 26.4 28.5 24.6,32.3 202 12.0% 23.7 18.0 15.3,20.6 1997 191 10.3% 23.4 24.7 21.2,28.3 221 12.7% 25.8 19.6 16.9,22.4 1998 245 12.7% 29.9 31.5 27.5,35.4 205 11.8% 23.9 17.6 15.1,20.2 1999 199 11.1% 24.3 25.3 21.8,28.9 203 11.6% 23.6 16.7 14.3,19.2 2000 201 11.4% 24.5 25.5 22.0,29.1 216 12.0% 25.0 18.6 16.0,21.2 2001 220 11.4% 26.7 26.7 23.1,30.3 180 10.3% 20.8 14.5 12.3,16.8 2002 202 10.6% 24.4 24.9 21.4,28.3 179 10.2% 20.6 14.7 12.4,17.0 2003 253 13.3% 30.4 30.4 26.6,34.2 214 11.6% 24.6 18.3 15.7,20.9 2004 230 11.9% 27.5 26.8 23.3,30.3 197 10.9% 22.5 16.1 13.7,18.4 2000-2004 1,106 11.7% 26.7 26.9 25.3,28.5 986 11.0% 22.7 16.5 15.4,17.6 1993-2004 2,645 11.8% 27.0 28.2 27.1,29.3 2,497 11.9% 24.3 17.9 17.2,18.7
Cancer of the colon (C18) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 1993 170 9.0% 21.3 23.7 20.1,27.4 181 10.4% 21.6 16.3 13.8,18.9 1994 156 8.4% 19.5 21.5 18.1,24.9 168 9.6% 20.0 15.6 13.1,18.2 1995 182 9.9% 22.6 24.7 21.0,28.3 173 10.5% 20.5 15.7 13.2,18.2 1996 151 8.2% 18.6 20.0 16.8,23.3 150 8.9% 17.6 13.3 11.0,15.6 1997 138 7.5% 16.9 17.8 14.8,20.8 172 9.9% 20.1 15.0 12.6,17.4 1998 179 9.3% 21.9 22.9 19.5,26.3 156 9.0% 18.2 13.0 10.9,15.2 1999 134 7.5% 16.4 17.3 14.3,20.2 163 9.3% 18.9 13.3 11.1,15.4 2000 142 8.0% 17.3 18.1 15.1,21.1 161 9.0% 18.7 14.0 11.7,16.3 2001 143 7.4% 17.3 17.7 14.8,20.6 125 7.1% 14.5 9.9 8.1,11.7 2002 147 7.7% 17.7 18.2 15.3,21.2 123 7.0% 14.2 9.8 7.9,11.6 2003 174 9.1% 20.9 20.6 17.5,23.7 141 7.7% 16.2 11.8 9.7,13.8 2004 145 7.5% 17.3 17.0 14.2,19.8 140 7.7% 16.0 11.1 9.1,13.0 2000-2004 751 8.0% 18.1 18.3 17.0,19.7 690 7.7% 15.9 11.3 10.4,12.2 1993-2004 1,861 8.3% 19.0 19.9 18.9,20.8 1,853 8.8% 18.0 13.2 12.5,13.8
Cancer of the rectum, rectosigmoid junction & anus (C19-C21) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 1993 68 3.6% 8.5 9.7 7.4,12.1 55 3.2% 6.6 4.7 3.4,6.1 1994 60 3.2% 7.5 8.4 6.2,10.5 57 3.2% 6.8 4.9 3.6,6.3 1995 54 2.9% 6.7 7.3 5.3,9.2 46 2.8% 5.4 4.2 2.9,5.5 1996 63 3.4% 7.8 8.4 6.3,10.5 52 3.1% 6.1 4.7 3.3,6.0 1997 53 2.9% 6.5 6.9 5.0,8.8 49 2.8% 5.7 4.6 3.2,6.0 1998 66 3.4% 8.1 8.6 6.5,10.6 49 2.8% 5.7 4.6 3.3,6.0 1999 65 3.6% 7.9 8.1 6.1,10.1 40 2.3% 4.6 3.5 2.3,4.6 2000 59 3.3% 7.2 7.5 5.6,9.4 55 3.1% 6.4 4.6 3.3,5.9 2001 77 4.0% 9.3 9.0 7.0,11.0 55 3.1% 6.4 4.6 3.3,5.9 2002 55 2.9% 6.6 6.6 4.8,8.4 56 3.2% 6.5 5.0 3.6,6.3 2003 79 4.2% 9.5 9.7 7.6,11.9 73 4.0% 8.4 6.6 5.0,8.2 2004 85 4.4% 10.2 9.8 7.7,11.9 57 3.1% 6.5 5.0 3.6,6.3 2000-2004 355 3.8% 8.6 8.5 7.6,9.4 296 3.3% 6.8 5.2 4.5,5.8 1993-2004 784 3.5% 8.0 8.3 7.7,8.9 644 3.1% 6.3 4.8 4.4,5.1 EASR: European age-standardised rate
Northern Ireland Cancer Registry 151
Survival of cancer patients in Northern Ireland: 1993-2004
Liver cancer (C22) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 1993 34 1.8% 4.3 4.7 3.1,6.3 37 2.1% 4.4 3.8 2.5,5.0 1994 38 2.0% 4.7 5.4 3.7,7.2 39 2.2% 4.6 3.6 2.4,4.7 1995 40 2.2% 5.0 5.2 3.6,6.8 26 1.6% 3.1 2.5 1.5,3.5 1996 37 2.0% 4.6 5.0 3.3,6.6 28 1.7% 3.3 2.4 1.5,3.4 1997 31 1.7% 3.8 4.0 2.6,5.4 39 2.2% 4.6 3.3 2.2,4.4 1998 49 2.5% 6.0 6.3 4.5,8.1 35 2.0% 4.1 3.0 2.0,4.1 1999 44 2.4% 5.4 5.8 4.1,7.5 33 1.9% 3.8 2.9 1.9,3.9 2000 43 2.4% 5.2 5.4 3.8,7.0 44 2.5% 5.1 3.9 2.7,5.2 2001 42 2.2% 5.1 5.2 3.6,6.8 26 1.5% 3.0 2.1 1.3,3.0 2002 38 2.0% 4.6 4.4 3.0,5.8 36 2.0% 4.1 3.3 2.2,4.5 2003 35 1.8% 4.2 4.1 2.7,5.5 33 1.8% 3.8 2.7 1.8,3.7 2004 36 1.9% 4.3 4.2 2.8,5.6 33 1.8% 3.8 2.9 1.9,4.0 2000-2004 194 2.1% 4.7 4.7 4.0,5.3 172 1.9% 4.0 3.0 2.5,3.5 1993-2004 467 2.1% 4.8 5.0 4.5,5.4 409 1.9% 4.0 3.0 2.7,3.3
Pancreatic cancer (C25) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 1993 72 3.8% 9.0 9.8 7.5,12.1 83 4.8% 9.9 7.6 5.8,9.3 1994 69 3.7% 8.6 9.1 7.0,11.3 80 4.6% 9.5 7.6 5.8,9.3 1995 70 3.8% 8.7 9.5 7.2,11.7 71 4.3% 8.4 6.5 5.0,8.1 1996 79 4.3% 9.7 10.3 8.0,12.7 74 4.4% 8.7 6.4 4.9,8.0 1997 80 4.3% 9.8 10.4 8.1,12.7 81 4.6% 9.5 7.1 5.4,8.7 1998 88 4.6% 10.7 11.6 9.1,14.0 68 3.9% 7.9 5.8 4.4,7.3 1999 75 4.2% 9.2 9.8 7.5,12.0 64 3.7% 7.4 5.4 4.0,6.8 2000 78 4.4% 9.5 9.8 7.6,12.0 86 4.8% 10.0 8.0 6.2,9.8 2001 90 4.7% 10.9 11.1 8.8,13.5 87 5.0% 10.1 7.3 5.7,9.0 2002 101 5.3% 12.2 12.2 9.8,14.6 90 5.1% 10.4 7.3 5.7,8.9 2003 71 3.7% 8.5 8.3 6.4,10.3 102 5.5% 11.7 8.3 6.6,10.0 2004 72 3.7% 8.6 8.3 6.4,10.3 79 4.4% 9.0 6.3 4.8,7.8 2000-2004 412 4.4% 9.9 9.9 9.0,10.9 444 5.0% 10.2 7.4 6.7,8.2 1993-2004 945 4.2% 9.6 10.0 9.4,10.7 965 4.6% 9.4 7.0 6.5,7.5
Cancer of the larynx (C32) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 1993 17 0.9% 2.1 2.5 1.3,3.8 8 0.5% 1.0 0.8 0.2,1.4 1994 18 1.0% 2.2 2.5 1.3,3.7 8 0.5% 1.0 0.8 0.2,1.4 1995 17 0.9% 2.1 2.3 1.2,3.3 <5 1996 15 0.8% 1.9 2.1 1.0,3.2 <5 1997 25 1.4% 3.1 3.4 2.1,4.8 6 0.3% 0.7 0.6 0.1,1.1 1998 23 1.2% 2.8 2.9 1.7,4.1 7 0.4% 0.8 0.6 0.1,1.1 1999 15 0.8% 1.8 2.0 1.0,3.0 8 0.5% 0.9 0.9 0.3,1.6 2000 16 0.9% 2.0 2.1 1.1,3.2 5 0.3% 0.6 0.5 0.0,1.0 2001 18 0.9% 2.2 2.3 1.2,3.3 <5 2002 23 1.2% 2.8 2.8 1.6,4.0 <5 2003 13 0.7% 1.6 1.5 0.7,2.4 5 0.3% 0.6 0.4 0.0,0.8 2004 12 0.6% 1.4 1.4 0.6,2.2 7 0.4% 0.8 0.6 0.1,1.0 2000-2004 82 0.9% 2.0 2.0 1.6,2.5 24 0.3% 0.6 0.5 0.3,0.7 1993-2004 212 0.9% 2.2 2.3 2.0,2.6 65 0.3% 0.6 0.5 0.4,0.7
Lung cancer (C33-C34) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 1993 540 28.7% 67.7 74.2 67.9,80.6 268 15.4% 32.0 28.6 25.0,32.2 1994 518 27.9% 64.6 71.1 65.0,77.3 263 15.0% 31.2 25.9 22.6,29.2 1995 490 26.6% 60.9 65.7 59.8,71.6 269 16.3% 31.8 27.7 24.3,31.2 1996 508 27.5% 62.7 66.9 61.0,72.8 277 16.4% 32.5 27.6 24.2,31.1 1997 500 27.0% 61.3 65.3 59.5,71.0 275 15.8% 32.1 26.6 23.3,29.9 1998 489 25.4% 59.7 61.8 56.2,67.3 302 17.4% 35.2 29.0 25.5,32.4 1999 480 26.7% 58.6 60.7 55.2,66.2 300 17.2% 34.9 28.0 24.7,31.4 2000 457 25.9% 55.7 57.5 52.2,62.8 330 18.4% 38.3 31.5 28.0,35.0 2001 508 26.4% 61.6 62.5 57.0,67.9 270 15.4% 31.2 26.0 22.8,29.2 2002 492 25.8% 59.4 59.6 54.3,65.0 319 18.1% 36.8 29.0 25.7,32.4 2003 476 25.0% 57.2 56.3 51.2,61.4 327 17.8% 37.6 29.3 26.0,32.6 2004 507 26.2% 60.6 57.4 52.3,62.4 326 18.0% 37.3 29.0 25.7,32.3 2000-2004 2,440 25.9% 58.9 58.6 56.3,61.0 1,572 17.6% 36.2 29.0 27.5,30.5 1993-2004 5,965 26.6% 60.8 63.0 61.4,64.6 3,526 16.8% 34.3 28.2 27.2,29.2 EASR: European age-standardised rate
152
Mortality rates by sex and cancer site
Bone cancer (C40-C41) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 2000-2004 22 0.2% 0.5 0.5 0.3,0.7 18 0.2% 0.4 0.3 0.2,0.4 1993-2004 67 0.3% 0.7 0.7 0.5,0.8 46 0.2% 0.4 0.4 0.3,0.5
Malignant melanoma (C43) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 1993 7 0.4% 0.9 1.0 0.2,1.7 20 1.1% 2.4 2.1 1.2,3.1 1994 14 0.8% 1.7 2.0 0.9,3.1 21 1.2% 2.5 2.3 1.3,3.3 1995 9 0.5% 1.1 1.2 0.4,2.0 16 1.0% 1.9 1.5 0.7,2.3 1996 11 0.6% 1.4 1.6 0.7,2.6 16 0.9% 1.9 1.4 0.7,2.2 1997 12 0.6% 1.5 1.6 0.7,2.5 14 0.8% 1.6 1.5 0.7,2.3 1998 13 0.7% 1.6 1.7 0.8,2.6 17 1.0% 2.0 1.5 0.8,2.3 1999 16 0.9% 2.0 2.0 1.0,3.0 18 1.0% 2.1 1.8 0.9,2.7 2000 13 0.7% 1.6 1.8 0.8,2.7 17 0.9% 2.0 1.7 0.9,2.6 2001 20 1.0% 2.4 2.5 1.4,3.6 15 0.9% 1.7 1.5 0.7,2.2 2002 18 0.9% 2.2 2.4 1.3,3.5 20 1.1% 2.3 1.6 0.8,2.3 2003 23 1.2% 2.8 2.8 1.6,4.0 17 0.9% 2.0 1.6 0.8,2.4 2004 24 1.2% 2.9 2.9 1.7,4.0 13 0.7% 1.5 1.0 0.4,1.6 2000-2004 98 1.0% 2.4 2.5 2.0,3.0 82 0.9% 1.9 1.5 1.1,1.8 1993-2004 180 0.8% 1.8 2.0 1.7,2.3 204 1.0% 2.0 1.6 1.4,1.9
Non-melanoma skin cancer (C44) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 2000-2004 36 0.4% 0.9 0.9 0.6,1.2 40 0.4% 0.9 0.5 0.3,0.7 1993-2004 85 0.4% 0.9 0.9 0.7,1.1 69 0.3% 0.7 0.4 0.3,0.5
Mesothelioma (C45) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 1993 31 1.6% 3.9 4.0 2.5,5.4 1994 24 1.3% 3.0 3.4 2.0,4.8 1995 28 1.5% 3.5 3.9 2.5,5.4 1996 20 1.1% 2.5 2.6 1.4,3.7 1997 37 2.0% 4.5 5.0 3.4,6.6 1998 32 1.7% 3.9 4.3 2.8,5.7 1999 43 2.4% 5.3 5.3 3.7,6.9 2000 30 1.7% 3.7 3.9 2.5,5.2 2001 50 2.6% 6.1 6.0 4.3,7.6 2002 45 2.4% 5.4 5.4 3.8,7.0 2003 33 1.7% 4.0 3.9 2.5,5.2 2004 45 2.3% 5.4 5.3 3.7,6.8 2000-2004 203 2.2% 4.9 4.9 4.2,5.5 23 0.3% 0.5 0.5 0.3,0.7 1993-2004 418 1.9% 4.3 4.4 4.0,4.9 42 0.2% 0.4 0.4 0.3,0.5
Breast cancer (C50) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 1993 329 18.9% 39.3 38.0 33.7,42.3 1994 338 19.2% 40.2 37.1 32.9,41.3 1995 327 19.8% 38.7 35.5 31.5,39.6 1996 305 18.1% 35.8 31.8 28.0,35.5 1997 259 14.8% 30.3 26.9 23.4,30.3 1998 299 17.2% 34.8 31.3 27.6,35.0 1999 290 16.6% 33.7 29.8 26.2,33.4 2000 286 16.0% 33.2 29.3 25.7,32.8 2001 315 18.0% 36.4 31.0 27.4,34.5 2002 278 15.8% 32.0 26.4 23.2,29.7 2003 282 15.3% 32.4 26.3 23.1,29.6 2004 323 17.8% 37.0 30.6 27.1,34.1 2000-2004 7 0.1 0.2 0.2 0.0,0.3 1,484 16.6% 34.2 28.7 27.2,30.2 1993-2004 21 0.1 0.2 0.2 0.1,0.3 3,631 17.3% 35.3 31.0 30.0,32.1 EASR: European age-standardised rate
Northern Ireland Cancer Registry 153
Survival of cancer patients in Northern Ireland: 1993-2004
Cervical cancer (C53) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 1993 34 1.9% 4.1 3.9 2.5,5.2 1994 37 2.1% 4.4 4.5 3.0,6.0 1995 20 1.2% 2.4 2.4 1.3,3.4 1996 44 2.6% 5.2 4.8 3.3,6.3 1997 27 1.5% 3.2 3.0 1.9,4.2 1998 33 1.9% 3.8 3.4 2.2,4.6 1999 35 2.0% 4.1 3.7 2.4,4.9 2000 31 1.7% 3.6 3.6 2.3,5.0 2001 24 1.4% 2.8 2.6 1.5,3.6 2002 24 1.4% 2.8 2.3 1.4,3.3 2003 31 1.7% 3.6 3.0 1.9,4.1 2004 37 2.0% 4.2 3.6 2.4,4.8 2000-2004 147 1.6% 3.4 3.0 2.5,3.5 1993-2004 377 1.8% 3.7 3.4 3.0,3.7
Cancer of the uterus (C54) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 1993 6 0.3% 0.7 0.5 0.1,0.9 1994 17 1.0% 2.0 1.7 0.9,2.6 1995 9 0.5% 1.1 0.9 0.3,1.5 1996 13 0.8% 1.5 1.1 0.4,1.7 1997 13 0.7% 1.5 1.3 0.5,2.0 1998 13 0.7% 1.5 1.3 0.6,2.0 1999 10 0.6% 1.2 0.9 0.3,1.6 2000 19 1.1% 2.2 1.8 0.9,2.6 2001 22 1.3% 2.5 1.9 1.0,2.7 2002 20 1.1% 2.3 1.8 1.0,2.7 2003 21 1.1% 2.4 1.8 1.0,2.6 2004 16 0.9% 1.8 1.4 0.7,2.1 2000-2004 98 1.1% 2.3 1.7 1.4,2.1 1993-2004 179 0.9% 1.7 1.4 1.2,1.6
Ovarian cancer (C56) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 1993 92 5.3% 11.0 10.2 8.0,12.4 1994 90 5.1% 10.7 9.6 7.5,11.7 1995 99 6.0% 11.7 11.6 9.2,13.9 1996 89 5.3% 10.5 9.3 7.3,11.4 1997 96 5.5% 11.2 10.1 8.0,12.2 1998 89 5.1% 10.4 8.9 7.0,10.9 1999 116 6.6% 13.5 12.4 10.0,14.7 2000 101 5.6% 11.7 10.0 8.0,12.1 2001 117 6.7% 13.5 12.0 9.7,14.2 2002 109 6.2% 12.6 10.3 8.3,12.4 2003 130 7.1% 14.9 12.0 9.9,14.2 2004 124 6.8% 14.2 11.1 9.0,13.1 2000-2004 581 6.5% 13.4 11.1 10.1,12.0 1993-2004 1,252 6.0% 12.2 10.6 10.0,11.2
Prostate cancer (C61) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 1993 181 9.6% 22.7 24.2 20.6,27.8 1994 211 11.4% 26.3 28.2 24.3,32.1 1995 219 11.9% 27.2 28.9 25.0,32.8 1996 206 11.1% 25.4 27.2 23.4,31.0 1997 208 11.2% 25.5 26.8 23.1,30.6 1998 222 11.5% 27.1 28.1 24.4,31.9 1999 197 11.0% 24.1 24.3 20.8,27.7 2000 209 11.8% 25.5 25.8 22.3,29.4 2001 214 11.1% 26.0 26.2 22.6,29.8 2002 192 10.1% 23.2 22.7 19.4,26.0 2003 219 11.5% 26.3 25.9 22.4,29.4 2004 240 12.4% 28.7 27.0 23.5,30.4 2000-2004 1,074 11.4% 25.9 25.5 24.0,27.1 1993-2004 2,518 11.2% 25.7 26.2 25.2,27.3 EASR: European age-standardised rate
154
Mortality rates by sex and cancer site
Testicular cancer (C62) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 2000-2004 15 0.2% 0.4 0.4 0.2,0.6 1993-2004 35 0.2% 0.4 0.4 0.2,0.5
Cancer of the kidney (C64-C66, C68) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 1993 42 2.2% 5.3 5.8 4.0,7.5 28 1.6% 3.3 3.0 1.8,4.2 1994 38 2.0% 4.7 5.3 3.6,7.0 22 1.3% 2.6 2.4 1.3,3.5 1995 48 2.6% 6.0 6.5 4.7,8.4 24 1.5% 2.8 2.4 1.4,3.4 1996 39 2.1% 4.8 5.4 3.7,7.1 16 0.9% 1.9 1.4 0.7,2.1 1997 42 2.3% 5.2 5.5 3.8,7.2 36 2.1% 4.2 3.3 2.1,4.4 1998 42 2.2% 5.1 5.6 3.9,7.2 36 2.1% 4.2 3.2 2.1,4.3 1999 38 2.1% 4.6 4.8 3.3,6.4 29 1.7% 3.4 2.6 1.6,3.6 2000 47 2.7% 5.7 6.1 4.3,7.8 35 2.0% 4.1 2.5 1.7,3.4 2001 47 2.4% 5.7 5.9 4.2,7.6 27 1.5% 3.1 2.5 1.5,3.5 2002 54 2.8% 6.5 6.8 4.9,8.6 30 1.7% 3.5 2.7 1.7,3.8 2003 67 3.5% 8.0 8.0 6.0,9.9 25 1.4% 2.9 2.2 1.3,3.1 2004 59 3.0% 7.1 6.9 5.2,8.7 45 2.5% 5.1 3.7 2.6,4.8 2000-2004 274 2.9% 6.6 6.7 5.9,7.6 162 1.8% 3.7 2.7 2.3,3.2 1993-2004 563 2.5% 5.7 6.1 5.6,6.6 353 1.7% 3.4 2.7 2.4,3.0
Cancer of the bladder (C67) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 1993 61 3.2% 7.6 8.5 6.4,10.7 28 1.6% 3.3 2.6 1.6,3.6 1994 52 2.8% 6.5 6.8 4.9,8.7 32 1.8% 3.8 2.4 1.6,3.3 1995 75 4.1% 9.3 9.9 7.6,12.2 34 2.1% 4.0 2.9 1.9,3.9 1996 63 3.4% 7.8 8.4 6.3,10.5 28 1.7% 3.3 2.2 1.3,3.0 1997 39 2.1% 4.8 5.0 3.4,6.6 39 2.2% 4.6 3.1 2.1,4.2 1998 52 2.7% 6.4 6.8 4.9,8.6 27 1.6% 3.1 2.0 1.2,2.8 1999 46 2.6% 5.6 5.9 4.2,7.7 42 2.4% 4.9 3.2 2.2,4.2 2000 58 3.3% 7.1 7.2 5.3,9.1 43 2.4% 5.0 3.6 2.5,4.8 2001 57 3.0% 6.9 6.9 5.1,8.8 32 1.8% 3.7 2.6 1.6,3.6 2002 50 2.6% 6.0 6.2 4.5,8.0 23 1.3% 2.7 1.7 1.0,2.5 2003 62 3.3% 7.4 7.5 5.6,9.4 25 1.4% 2.9 1.9 1.1,2.6 2004 49 2.5% 5.9 5.6 4.0,7.2 25 1.4% 2.9 1.8 1.0,2.5 2000-2004 276 2.9% 6.7 6.7 5.9,7.5 148 1.7% 3.4 2.3 1.9,2.7 1993-2004 664 3.0% 6.8 7.0 6.5,7.6 378 1.8% 3.7 2.5 2.2,2.8
Cancer of the brain (C71) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 1993 49 2.6% 6.1 6.8 4.8,8.7 29 1.7% 3.5 3.5 2.2,4.8 1994 38 2.0% 4.7 5.3 3.6,6.9 37 2.1% 4.4 4.8 3.2,6.3 1995 43 2.3% 5.3 6.0 4.2,7.8 30 1.8% 3.5 3.3 2.1,4.6 1996 47 2.5% 5.8 6.4 4.5,8.2 20 1.2% 2.3 2.2 1.2,3.2 1997 44 2.4% 5.4 5.8 4.0,7.5 39 2.2% 4.6 4.2 2.9,5.6 1998 50 2.6% 6.1 6.7 4.8,8.5 33 1.9% 3.8 3.7 2.4,5.0 1999 36 2.0% 4.4 4.7 3.1,6.2 26 1.5% 3.0 2.8 1.7,3.9 2000 42 2.4% 5.1 5.5 3.8,7.2 36 2.0% 4.2 4.0 2.6,5.3 2001 45 2.3% 5.5 5.7 4.0,7.4 33 1.9% 3.8 3.6 2.4,4.9 2002 54 2.8% 6.5 6.6 4.8,8.4 36 2.0% 4.1 3.7 2.5,5.0 2003 51 2.7% 6.1 6.2 4.5,7.9 34 1.8% 3.9 3.4 2.2,4.6 2004 41 2.1% 4.9 5.0 3.5,6.5 32 1.8% 3.7 3.4 2.2,4.7 2000-2004 233 2.5% 5.6 5.8 5.0,6.5 171 1.9% 3.9 3.6 3.1,4.2 1993-2004 540 2.4% 5.5 5.9 5.4,6.4 385 1.8% 3.7 3.6 3.2,3.9
Hodgkin’s disease (C81) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 2000-2004 25 0.3% 0.6 0.6 0.4,0.8 15 0.2% 0.3 0.3 0.2,0.5 1993-2004 67 0.3% 0.7 0.7 0.5,0.9 46 0.2% 0.4 0.4 0.3,0.5 EASR: European age-standardised rate
Northern Ireland Cancer Registry 155
Survival of cancer patients in Northern Ireland: 1993-2004
Non-Hodgkin’s lymphoma (C82-C85, C96) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 1993 64 3.4% 8.0 9.0 6.8,11.2 42 2.4% 5.0 3.9 2.6,5.2 1994 68 3.7% 8.5 9.1 6.9,11.3 43 2.4% 5.1 4.0 2.7,5.2 1995 60 3.3% 7.5 8.2 6.1,10.3 40 2.4% 4.7 3.9 2.7,5.2 1996 57 3.1% 7.0 7.7 5.7,9.7 64 3.8% 7.5 6.2 4.6,7.7 1997 67 3.6% 8.2 8.9 6.8,11.1 58 3.3% 6.8 5.7 4.2,7.3 1998 68 3.5% 8.3 8.8 6.7,10.9 72 4.1% 8.4 7.0 5.3,8.7 1999 51 2.8% 6.2 6.5 4.7,8.3 71 4.1% 8.3 6.9 5.2,8.6 2000 51 2.9% 6.2 6.6 4.8,8.4 56 3.1% 6.5 5.4 3.9,6.8 2001 74 3.8% 9.0 9.1 7.0,11.3 66 3.8% 7.6 5.8 4.3,7.3 2002 61 3.2% 7.4 7.4 5.5,9.3 66 3.8% 7.6 5.9 4.4,7.4 2003 58 3.0% 7.0 6.9 5.1,8.7 70 3.8% 8.0 5.7 4.3,7.1 2004 64 3.3% 7.7 7.3 5.5,9.1 46 2.5% 5.3 3.7 2.6,4.9 2000-2004 308 3.3% 7.4 7.5 6.6,8.3 304 3.4% 7.0 5.3 4.7,5.9 1993-2004 743 3.3% 7.6 7.9 7.4,8.5 694 3.3% 6.7 5.3 4.9,5.8
Multiple myeloma (C90) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 1993 31 1.6% 3.9 4.3 2.8,5.9 33 1.9% 3.9 3.6 2.3,4.9 1994 31 1.7% 3.9 4.2 2.7,5.7 35 2.0% 4.2 3.2 2.1,4.3 1995 39 2.1% 4.9 5.5 3.7,7.2 36 2.2% 4.3 3.3 2.2,4.5 1996 28 1.5% 3.5 4.0 2.5,5.5 15 0.9% 1.8 1.3 0.6,2.1 1997 35 1.9% 4.3 4.5 3.0,6.0 20 1.1% 2.3 1.7 0.9,2.5 1998 37 1.9% 4.5 4.6 3.1,6.1 26 1.5% 3.0 2.3 1.4,3.3 1999 33 1.8% 4.0 4.3 2.8,5.7 26 1.5% 3.0 2.3 1.4,3.3 2000 34 1.9% 4.1 4.2 2.8,5.7 33 1.8% 3.8 2.9 1.9,3.9 2001 24 1.2% 2.9 2.9 1.7,4.1 30 1.7% 3.5 2.4 1.5,3.4 2002 31 1.6% 3.7 3.6 2.3,4.9 23 1.3% 2.7 1.6 0.9,2.4 2003 33 1.7% 4.0 3.9 2.5,5.2 33 1.8% 3.8 2.6 1.6,3.5 2004 34 1.8% 4.1 4.0 2.6,5.3 26 1.4% 3.0 2.0 1.2,2.8 2000-2004 156 1.7% 3.8 3.7 3.1,4.3 145 1.6% 3.3 2.3 1.9,2.7 1993-2004 390 1.7% 4.0 4.1 3.7,4.6 336 1.6% 3.3 2.4 2.2,2.7
Leukaemia (C91-C95) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 1993 41 2.2% 5.1 5.4 3.7,7.1 42 2.4% 5.0 4.4 3.0,5.8 1994 58 3.1% 7.2 7.8 5.8,9.8 36 2.0% 4.3 3.8 2.5,5.1 1995 51 2.8% 6.3 6.6 4.7,8.4 34 2.1% 4.0 3.4 2.2,4.6 1996 46 2.5% 5.7 5.9 4.2,7.6 41 2.4% 4.8 4.1 2.8,5.5 1997 54 2.9% 6.6 6.9 5.0,8.7 56 3.2% 6.5 5.4 3.9,6.9 1998 57 3.0% 7.0 7.5 5.5,9.5 35 2.0% 4.1 3.3 2.1,4.4 1999 66 3.7% 8.1 8.2 6.2,10.2 38 2.2% 4.4 3.4 2.2,4.5 2000 57 3.2% 6.9 7.2 5.3,9.1 34 1.9% 3.9 2.9 1.9,4.0 2001 48 2.5% 5.8 6.0 4.2,7.7 40 2.3% 4.6 3.3 2.2,4.4 2002 60 3.1% 7.2 7.5 5.6,9.4 37 2.1% 4.3 3.1 2.1,4.2 2003 42 2.2% 5.0 4.9 3.4,6.3 39 2.1% 4.5 3.3 2.2,4.5 2004 51 2.6% 6.1 6.0 4.3,7.6 43 2.4% 4.9 3.3 2.2,4.3 2000-2004 258 2.7% 6.2 6.3 5.5,7.1 193 2.2% 4.4 3.2 2.7,3.7 1993-2004 631 2.8% 6.4 6.6 6.1,7.2 475 2.3% 4.6 3.6 3.3,4.0
Childhood cancer (Ages 0-14; C00-C97, ex. C44) Male Female Year of %cancer Crude EASR %cancer Crude EASR death Deaths EASR Deaths EASR deaths rate 95% CI deaths rate 95% CI 2000-2004 32 0.3% 3.4 3.5 2.3,4.7 12 0.1% 1.3 1.3 0.6,2.1 1993-2004 92 0.4% 3.9 4.0 3.2,4.8 47 0.2% 2.1 2.1 1.5,2.7 EASR: European age-standardised rate
156
Annual percentage changes by sex and cancer site
A6: ANNUAL PERCENTAGE CHANGES BY SEX AND CANCER SITE (1993-2004)
Incidence MALE FEMALE Annual percentage Annual Annual percentage Annual change (APC) change change (APC) change Cancer Site Period of Period of in in diagnosis p- diagnosis p- APC 95% CI number APC 95% CI number value value of cases of cases All cancers excluding 93-99 -1.6 -2.3,-0.8 0.002 -12.1 93-04 0.2 -0.1,0.6 0.146 40.6 NMSC (C00-C97, ex. C44) 99-04 0.8 -0.2,1.8 0.113 86.9 Lip, oral cavity & pharynx 93-04 -3.0 -4.7,-1.4 0.002 -1.6 93-04 -1.4 -3.7, 1.0 0.228 -0.6 (C00-C14) Oesophagus 93-04 -1.0 -3.2,1.3 0.342 0.4 93-04 -1.0 -3.9, 1.9 0.441 -0.1 (C15) Stomach 93-04 -2.5 -4.3,-0.6 0.015 -1.5 93-04 -2.2 -3.9, -0.4 0.021 -1.0 (C16) Colorectal 93-04 -0.8 -1.9,0.3 0.145 3.4 93-04 -1.3 -2.0, -0.6 0.003 -1.7 (C18-C21) Colon 93-04 -1.6 -2.4,-0.8 0.001 0.0 93-04 -1.9 -3.2, -0.6 0.010 -2.8 (C18) Rectum, rectosigmoid 93-04 0.5 -1.6,2.7 0.590 3.4 93-04 0.2 -1.7, 2.2 0.829 1.1 junction & anus (C19-C21) Liver 93-04 -1.0 -4.6,2.8 0.581 0.1 93-04 -3.9 -8.9, 1.4 0.133 -1.1 (C22) Pancreas 93-04 -1.6 -4.8,1.8 0.315 -0.2 93-04 0.2 -2.3, 2.9 0.848 1.0 (C25) Larynx 93-04 -3.0 -5.3,-0.7 0.017 -0.8 93-04 -1.0 -5.2, 3.3 0.594 -0.1 (C32) Lung 93-04 -2.4 -3.4,-1.3 0.001 -4.0 93-04 0.0 -0.7, 0.8 0.906 4.5 (C33-C34) Malignant melanoma 93-98 -5.6 -12.7, 2.2 0.130 -2.9 93-04 3.5 1.5, 5.6 0.003 3.8 (C43) 98-04 5.1 1.8, 8.5 0.008 6.1 Mesothelioma 93-04 2.2 -1.9, 6.6 0.262 1.4 93-04 -1.0 -10.2, 9.3 0.832 0.3 (C45) Breast - - - - - 93-04 1.4 0.7, 2.1 0.002 23.8 (C50) Cervix - - - - - 93-04 -2.5 -4.4, -0.6 0.014 -1.0 (C53) Uterus - - - - - 93-04 5.3 3.5, 7.1 0.000 7.6 (C54) Ovary - - - - - 93-04 1.4 0.1, 2.8 0.044 5.0 (C56) Prostate 93-99 -0.4 -3.2, 2.6 0.782 2.4 - - - - - (C61) 99-04 7.6 4.2, 11.2 0.001 54.3 Testis 93-04 2.0 -0.4, 4.4 0.083 1.4 - - - - - (C62) Kidney 93-04 0.0 -1.6, 1.6 0.994 1.5 93-04 0.4 -1.9, 2.7 0.703 1.2 (C64-C66, C68) Bladder 93-04 -1.8 -4.0, 0.4 0.090 -0.4 93-04 -1.5 -5.8, 3.0 0.477 -0.4 (C67) Brain 93-04 -0.6 -3.3, 2.2 0.647 0.3 93-04 -0.6 -5.4, 4.3 0.774 0.4 (C71) Hodgkin’s disease 93-04 -4.2 -8.8, 0.6 0.077 -0.7 93-04 1.2 -1.9, 4.4 0.410 0.2 (C81) Non-Hodgkin’s lymphoma 93-04 -0.6 -2.0, 0.9 0.383 1.0 93-04 1.2 -0.8, 3.2 0.219 3.3 (C82-C85, C96) Multiple myeloma 93-04 0.7 -2.5, 3.9 0.648 1.3 93-04 -1.8 -4.4, 0.8 0.157 -0.2 (C90) Leukaemia 93-04 -2.0 -4.4, 0.4 0.090 -1.1 93-04 -2.1 -5.3, 1.2 0.180 -0.6 (C91-C95) Childhood (Ages 0-14) 93-04 -2.4 -5.3, 0.6 0.105 -0.9 93-04 0.3 -3.5, 4.2 0.880 -0.2 All cancers ex. NMSC Annual percentage changes in blue represent significant trends.
Northern Ireland Cancer Registry 157
Survival of cancer patients in Northern Ireland: 1993-2004
Mortality MALE FEMALE Annual percentage Annual Annual percentage Annual change (APC) change change (APC) Change Cancer Site Period of Period of in in death p- death p- APC 95% CI number APC 95% CI number value value of deaths of deaths All cancers excluding 93-04 -1.3 -1.8, -0.9 0.000 4.6 93-04 -0.8 -1.3, -0.4 0.003 9.2 NMSC (C00-C97, ex. C44) Lip, oral cavity & pharynx 93-04 -2.6 -5.1, 0.0 0.049 -0.3 93-04 1.5 -5.8, 8.8 0.671 0.0 (C00-C14) Oesophagus 93-02 1.6 -1.2, 4.5 0.221 0.9 93-04 0.4 -1.4, 2.4 0.607 1.9 (C15) 02-04 -11.0 -22.4, 2.0 0.083 -2.5 Stomach 93-04 -3.6 -5.5, -1.7 0.002 -2.0 93-04 -1.6 -4.2, 1.0 0.196 -0.3 (C16) Colorectal 93-04 -1.5 -3.2, 0.2 0.083 0.1 93-04 -2.5 -4.0, -1.0 0.005 -3.3 (C18-C21) Colon 93-04 -2.4 -4.3, -0.5 0.017 -1.5 93-04 -4.0 -5.7, -2.3 0.000 -4.2 (C18) Rectum, rectosigmoid 93-04 0.7 -1.8, 3.2 0.564 1.6 93-04 1.8 -0.8, 4.4 0.148 0.9 junction & anus (C19-C21) Liver 93-04 -1.4 -4.0, 1.4 0.296 0.1 93-04 -1.4 -4.9, 2.2 0.395 0.1 (C22) Pancreas 93-04 -0.1 -2.5, 2.4 0.945 0.9 93-04 0.3 -2.1, 2.8 0.770 1.3 (C25) Larynx 93-04 -3.3 -7.6, 1.2 0.128 -0.3 93-04 -3.1 -9.6, 3.9 0.338 -0.1 (C32) Lung 93-04 -2.2 -2.8, -1.6 0.000 -3.0 93-04 0.6 -0.4, 1.6 0.206 5.9 (C33-C34) Malignant melanoma 93-04 7.3 4.1, 10.5 0.000 1.3 93-04 -3.5 -6.4, -0.4 0.030 -0.3 (C43) Mesothelioma -23.4, 93-04 3.5 -0.2, 7.4 0.063 1.7 93-04 13.0 0.500 0.3 (C45) 66.5 Breast - - - - - 93-04 -2.6 -4.1, -1.1 0.003 -2.8 (C50) Cervix - - - - - 93-04 -2.7 -6.6, 1.4 0.174 -0.3 (C53) Uterus - - - - - 93-04 5.5 -0.2, 11.5 0.058 1.0 (C54) Ovary - - - - - 93-04 1.3 -0.6, 3.2 0.168 3.4 (C56) Prostate 93-04 -0.6 -1.8, 0.7 0.339 1.9 - - - - - (C61) Testis -30.9, 93-04 -3.8 0.797 -0.1 - - - - - (C62) 33.8 Kidney 93-04 2.5 0.3, 4.7 0.030 1.9 93-04 1.4 -2.6, 5.6 0.455 1.1 (C64-C66, C68) Bladder 93-04 -2.7 -5.7, 0.4 0.083 -0.7 93-04 -2.2 -6.8, 2.6 0.326 -0.4 (C67) Brain 93-04 -0.8 -3.0, 1.4 0.433 0.3 93-04 -0.7 -4.0, 2.8 0.666 0.3 (C71) Hodgkin’s disease 93-04 -5.5 -9.8, -1.0 0.023 -0.2 93-04 -5.3 -14.4, 4.9 0.262 -0.3 (C81) Non-Hodgkin’s lymphoma 93-99 14.1 1.5, 28.2 0.032 5.8 93-04 -2.0 -4.0, 0.0 0.050 -0.2 (C82-C85, C96) 99-04 -6.4 -14.0, 1.8 0.104 -2.4 Multiple myeloma 93-04 -2.2 -4.6, 0.2 0.072 -0.1 93-04 -3.6 -8.0, 1.0 0.106 -0.3 (C90) Leukaemia 93-04 -0.8 -3.7, 2.3 0.587 0.2 93-04 -2.9 -5.7, -0.5 0.047 0.0 (C91-C95) Childhood (Ages 0-14) 93-04 -3.1 -9.5, 3.7 0.329 -0.3 93-04 -7.2 -16.1, 2.7 0.133 -0.3 All cancers ex. NMSC Annual percentage changes in blue represent significant trends.
158
Relative survival by sex and cancer site
A7: RELATIVE SURVIVAL BY SEX AND CANCER SITE (1993-2004)
Cancer FIVE-YEAR RELATIVE SURVIVAL (95% CI) Site Male Female 1993-1996 1997-2000 2001-2004* 1993-1996 1997-2000 2001-2004* All cancers excluding (34.6%, (38.3%, (41.6%, (46.5%, (50.2%, (52.0%, NMSC (C00-C97, ex. 35.7% 39.4% 42.8% 47.5% 51.2% 53.1% 36.7%) 40.4%) 44.0%) 48.5%) 52.2%) 54.0%) C44) Lip, oral cavity & (43.2%, (42.9%, (46.6%, (42.4%, (30.8%, (46.2%, pharynx 49.3% 49.3% 53.9% 50.9% 39.1% 57.1% 55.4%) 55.6%) 61.2%) 59.3%) 47.3%) 68.1%) (C00-C14) Oesophagus (3.0%, (9.3%, (6.5%, (9.0%, (7.6%, (11.4%, 5.7% 13.2% 10.3% 14.4% 12.3% 17.9% (C15) 8.4%) 17.2%) 14.1%) 19.8%) 17.0%) 24.4%) Stomach (11.9%, (13.3%, (15.0%, (10.8%, (13.0%, (12.1%, 15.2% 16.8% 19.2% 14.8% 17.3% 16.9% (C16) 18.5%) 20.3%) 23.4%) 18.8%) 21.7%) 21.6%) Colorectal (43.9%, (48.9%, (49.0%, (42.9%, (50.2%, (51.3%, 46.7% 51.9% 52.2% 45.7% 53.1% 54.5% (C18-C21) 49.5%) 54.8%) 55.4%) 48.5%) 56.0%) 57.8%) Colon (43.2%, (49.7%, (48.2%, (43.6%, (50.4%, (52.3%, 46.8% 53.5% 52.3% 47.0% 53.9% 56.3% (C18) 50.4%) 57.2%) 56.3%) 50.4%) 57.4%) 60.3%) Rectum, rectosigmoid (42.0%, (44.4%, (46.5%, (37.8%, (46.0%, (45.2%, junction & anus (C19- 46.6% 49.2% 51.7% 42.8% 51.2% 50.8% 51.1%) 54.0%) 56.8%) 47.8%) 56.5%) 56.4%) C21) Larynx (53.7%, (61.6%, (67.7%, (43.7%, (41.6%, (39.2%, 62.0% 69.6% 76.6% 59.9% 57.9% 56.6% (C32) 70.2%) 77.6%) 85.4%) 76.2%) 74.2%) 74.0%) Lung (5.7%, (7.7%, (6.7%, (7.4%, (7.5%, (8.0%, 6.9% 9.1% 8.1% 9.1% 9.2% 10.1% (C33-C34) 8.1%) 10.5%) 9.6%) 10.9%) 10.9%) 12.1%) Malignant melanoma (80.6%, (79.4%, (75.2%, (87.5%, (91.4%, (92.6%, 86.5% 85.8% 82.0% 91.5% 95.3% 96.7% (C43) 92.4%) 92.2%) 88.8%) 95.5%) 99.3%) 100.8%) Breast (73.7%, (78.4%, (79.8%, ------75.5% 80.1% 81.6% (C50) 77.4%) 81.8%) 83.5%) Cervix (56.3%, (62.3%, (63.8%, ------61.8% 67.8% 69.7% (C53) 67.3%) 73.2%) 75.7%) Uterus (60.4%, (67.7%, (70.3%, ------66.1% 72.5% 75.2% (C54) 71.8%) 77.3%) 80.0%) Ovary (37.3%, (39.0%, (39.2%, ------41.6% 43.0% 43.6% (C56) 45.9%) 47.0%) 48.1%) Prostate (52.4%, (61.4%, (68.8%, 55.6% 64.5% 72.2% ------(C61) 58.8%) 67.6%) 75.6%) Testis (88.3%, (92.8%, (90.3%, 92.4% 96.0% 94.0% ------(C62) 96.4%) 99.2%) 97.8%) Kidney (43.7%, (46.7%, (42.4%, (43.5%, (43.2%, (47.1%, 50.1% 53.0% 48.9% 51.1% 50.3% 55.1% (C64-C66, C68) 56.4%) 59.4%) 55.3%) 58.8%) 57.4%) 63.2%) Bladder (52.1%, (53.2%, (53.1%, (34.1%, (38.0%, (38.3%, 57.5% 58.7% 59.3% 41.5% 45.9% 47.2% (C67) 62.9%) 64.2%) 65.4%) 49.0%) 53.9%) 56.1%) Brain (7.9%, (11.7%, (14.3%, (11.7%, (14.8%, (13.6%, 12.5% 17.0% 20.2% 18.2% 21.0% 20.5% (C71) 17.1%) 22.2%) 26.2%) 24.7%) 27.3%) 27.4%) Hodgkin’s disease (61.0%, (68.3%, (74.3%, (66.8%, (65.0%, (61.1%, 71.3% 78.5% 83.8% 77.9% 77.1% 74.7% (C81) 81.7%) 88.7%) 93.4%) 89.0%) 89.2%) 88.2%) Non-Hodgkin’s (40.9%, (43.3%, (47.5%, (40.5%, (47.8%, (51.9%, lymphoma 46.2% 48.6% 53.4% 45.9% 52.9% 57.5% 51.5%) 53.9%) 59.3%) 51.3%) 58.0%) 63.1%) (C82-C85, C96) Multiple myeloma (14.6%, (21.8%, (27.6%, (16.8%, (27.8%, (27.4%, 21.8% 29.0% 36.8% 23.8% 35.7% 36.6% (C90) 29.1%) 36.2%) 45.9%) 30.9%) 43.7%) 45.9%) Leukaemia (24.1%, (25.3%, (30.9%, (28.7%, (24.9%, (27.9%, 30.0% 31.0% 37.9% 36.0% 31.6% 36.1% (C91-C95) 36.0%) 36.7%) 45.0%) 43.3%) 38.3%) 44.3%) Childhood (Ages 0-14) (65.8%, (65.8%, (59.2%, (67.5%, (65.6%, (67.8%, 73.7% 74.0% 69.3% 76.2% 75.5% 78.2% All cancers ex. NMSC 81.6%) 82.2%) 79.3%) 84.9%) 85.4%) 88.7%) * Estimated using period analysis. Results in blue indicate significant improvement in survival between consecutive periods of diagnosis.
Northern Ireland Cancer Registry 159
Survival of cancer patients in Northern Ireland: 1993-2004
A8: RELATIVE SURVIVAL BY SEX, AGE AND CANCER SITE (1993-2003)
All cancers excluding non-melanoma skin cancer (C00-C97, ex. C44) RELATIVE SURVIVAL (95% CI) Aged 15-99 1-YEAR Aged 15-44 Aged 45-54 Aged 55-64 Aged 65-74 Aged 75-99 (age- standardised) (78.6%, (60.1%, (55.2%, (51.1%, (47.7%, (55.2%, Male 81.3% 63.1% 57.3% 52.7% 49.5% 56.1% 1993- 84.0%) 66.2%) 59.4%) 54.3%) 51.3%) 57.1%) 1996 (89.3%, (80.7%, (70.3%, (57.0%, (46.5%, (62.6%, Female 90.9% 82.6% 72.2% 58.8% 48.3% 63.5% 92.6%) 84.4%) 74.0%) 60.6%) 50.1%) 64.4%) (81.2%, (66.5%, (58.8%, (55.1%, (47.4%, (57.9%, Male 83.9% 69.4% 60.8% 56.7% 49.2% 58.9% 1997- 86.5%) 72.3%) 62.9%) 58.4%) 51.0%) 59.8%) 2000 (89.3%, (83.9%, (74.4%, (58.5%, (48.4%, (64.8%, Female 90.8% 85.6% 76.1% 60.3% 50.1% 65.6% 92.4%) 87.2%) 77.8%) 62.0%) 51.7%) 66.5%) (82.7%, (66.5%, (63.3%, (60.2%, (50.1%, (61.2%, Male 85.7% 69.4% 65.5% 62.0% 52.1% 62.3% 2001- 88.6%) 72.3%) 67.7%) 63.8%) 54.1%) 63.3%) 2003 (90.4%, (85.1%, (78.6%, (60.9%, (47.2%, (66.3%, Female 92.1% 87.0% 80.4% 63.0% 49.1% 67.3% 93.8%) 88.9%) 82.1%) 65.0%) 51.0%) 68.2%) 5-YEAR (63.2%, (40.5%, (32.2%, (30.8%, (27.8%, (35.1%, Male 66.6% 43.6% 34.3% 32.6% 30.0% 36.1% 1993- 69.9%) 46.8%) 36.5%) 34.3%) 32.2%) 37.2%) 1996 (72.7%, (62.7%, (51.5%, (38.2%, (29.6%, (44.9%, Female 75.2% 65.1% 53.6% 40.2% 31.7% 45.9% 77.6%) 67.5%) 55.8%) 42.1%) 33.7%) 46.9%) (63.7%, (42.5%, (38.2%, (36.1%, (30.3%, (38.9%, Male 67.1% 45.7% 40.3% 37.9% 32.5% 40.0% 1997- 70.6%) 48.9%) 42.5%) 39.8%) 34.7%) 41.1%) 2000 (75.2%, (66.7%, (57.2%, (40.4%, (34.0%, (48.6%, Female 77.5% 68.9% 59.2% 42.3% 36.1% 49.6% 79.8%) 71.2%) 61.3%) 44.2%) 38.1%) 50.6%)
Cancer of the lip, oral cavity and pharynx (C00-C14) RELATIVE SURVIVAL (95% CI) Aged 15-99 1-YEAR Aged 15-44 Aged 45-54 Aged 55-64 Aged 65-74 Aged 75-99 (age- standardised) (81.5%, (58.7%, (62.2%, (61.5%, (51.6%, (66.7%, Male 92.1% 70.3% 72.1% 70.1% 64.0% 71.5% 1993- 102.8%) 82.0%) 82.0%) 78.7%) 76.4%) 76.4%) 1996 (86.2%, (77.1%, (52.6%, (62.4%, (52.7%, (69.7%, Female 95.3% 90.3% 69.6% 75.1% 65.0% 76.4% 104.4%) 103.5%) 86.6%) 87.7%) 77.4%) 83.0%) (74.5%, (78.1%, (64.6%, (56.2%, (52.1%, (69.2%, Male 89.0% 87.2% 73.9% 66.3% 64.6% 74.1% 1997- 103.6%) 96.4%) 83.3%) 76.5%) 77.1%) 78.9%) 2000 (47.9%, (59.1%, (51.8%, (37.4%, (61.4%, Female - - 66.9% 73.5% 65.4% 51.8% 68.3% 85.8%) 87.9%) 79.0%) 66.3%) 75.2%) (74.5%, (74.9%, (64.0%, (60.1%, (54.0%, (70.6%, Male 89.0% 85.7% 75.0% 72.1% 68.3% 76.2% 2001- 103.6%) 96.6%) 86.0%) 84.0%) 82.6%) 81.9%) 2003 (74.0%, (80.9%, (73.2%, (64.0%, (63.1%, (78.2%, Female 91.0% 93.6% 86.2% 80.6% 78.5% 85.1% 108.0%) 106.3%) 99.3%) 97.1%) 94.0%) 91.9%) 5-YEAR (64.9%, (28.4%, (40.7%, (38.8%, (23.3%, (43.8%, Male 80.7% 41.2% 52.3% 49.6% 41.2% 50.0% 1993- 96.5%) 54.0%) 64.0%) 60.4%) 59.2%) 56.1%) 1996 (58.2%, (45.0%, (14.9%, (37.5%, (26.5%, (42.2%, Female 76.5% 66.3% 32.6% 53.4% 43.5% 50.5% 94.8%) 87.7%) 50.2%) 69.3%) 60.4%) 58.8%) (52.0%, (49.8%, (41.3%, (31.5%, (18.6%, (44.4%, Male 72.8% 63.5% 52.6% 43.5% 34.4% 50.6% 1997- 93.7%) 77.1%) 63.9%) 55.5%) 50.1%) 56.8%) 2000 (24.3%, (30.3%, (19.6%, (12.8%, (35.4%, Female - - 45.1% 47.2% 34.0% 29.1% 43.5% 65.8%) 64.1%) 48.5%) 45.5%) 51.6%)
Oesophageal cancer (C15) RELATIVE SURVIVAL (95% CI) Aged 15-99 1-YEAR Aged 15-44 Aged 45-54 Aged 55-64 Aged 65-74 Aged 75-99 (age- standardised) (19.3%, (21.7%, (22.1%, (6.2%, (20.8%, Male - - 35.5% 31.8% 30.8% 13.8% 25.6% 1993- 51.6%) 42.0%) 39.5%) 21.5%) 30.3%) 1996 (28.2%, (18.9%, (15.0%, (27.8%, Female - - - - 46.8% 30.4% 22.7% 34.8% 65.5%) 41.8%) 30.3%) 41.9%) (30.9%, (25.8%, (31.0%, (12.9%, (28.9%, Male - - 45.7% 35.6% 40.6% 21.9% 34.1% 1997- 60.4%) 45.3%) 50.2%) 31.0%) 39.2%) 2000 (26.6%, (24.2%, (13.0%, (26.8%, Female - - - - 42.4% 35.5% 20.5% 33.2% 58.3%) 46.7%) 28.1%) 39.5%) (45.2%, (19.7%, (20.3%, (12.4%, (25.6%, Male - - 60.8% 32.5% 30.5% 21.6% 31.2% 2001- 76.4%) 45.2%) 40.8%) 30.8%) 36.7%) 2003 (41.2%, (26.2%, (18.5%, (34.1%, Female - - - - 61.3% 40.3% 28.8% 42.2% 81.3%) 54.4%) 39.2%) 50.3%) 5-YEAR (2.9%, Male ------5.6% 1993- 8.3%) 1996 (7.7%, (11.7%, Female ------17.8% - - 17.6% 27.9%) 23.6%) (9.1%, (5.4%, (8.4%, Male - - - - 17.1% 12.4% - - 12.3% 1997- 25.1%) 19.3%) 16.3%) 2000 (10.9%, Female ------15.9% 21.0%)
160
Relative survival by sex, age and cancer site
Stomach cancer (C16) RELATIVE SURVIVAL (95% CI) Aged 15-99 1-YEAR Aged 15-44 Aged 45-54 Aged 55-64 Aged 65-74 Aged 75-99 (age- standardised) (19.9%, (31.8%, (40.7%, (35.0%, (16.3%, (31.8%, Male 42.2% 46.8% 49.6% 41.6% 22.7% 35.7% 1993- 64.4%) 61.7%) 58.4%) 48.2%) 29.2%) 39.6%) 1996 (24.6%, (26.8%, (28.1%, (18.3%, (28.5%, Female - - 44.1% 39.3% 38.2% 24.7% 33.5% 63.6%) 51.9%) 48.4%) 31.2%) 38.5%) (37.1%, (36.7%, (26.5%, (19.6%, (30.4%, Male - - 50.2% 45.5% 33.4% 26.2% 34.3% 1997- 63.4%) 54.2%) 40.3%) 32.8%) 38.3%) 2000 (32.3%, (33.1%, (15.4%, (30.1%, Female - - - - 47.0% 42.3% 22.0% 35.2% 61.7%) 51.4%) 28.6%) 40.2%) (26.9%, (30.4%, (33.7%, (36.5%, (23.5%, (34.8%, Male 50.1% 47.3% 44.0% 44.5% 31.2% 39.4% 2001- 73.2%) 57.5%) 54.2%) 52.6%) 38.9%) 44.0%) 2003 (46.8%, (25.5%, (18.9%, (30.5%, Female - - - - 62.6% 36.1% 26.6% 36.4% 78.3%) 46.6%) 34.2%) 42.3%) 5-YEAR (12.6%, (7.7%, (7.0%, (11.6%, Male - - - - 20.0% 12.7% 14.1% 15.3% 1993- 27.4%) 17.6%) 21.2%) 19.0%) 1996 (9.1%, (12.2%, (2.1%, (11.4%, Female - - - - 19.5% 21.4% 6.6% 15.5% 30.0%) 30.5%) 11.1%) 19.6%) (7.3%, (12.0%, (9.6%, (10.0%, (13.4%, Male - - 17.7% 19.2% 15.3% 17.4% 17.3% 1997- 28.1%) 26.5%) 21.1%) 24.9%) 21.1%) 2000 (14.2%, (7.4%, (13.2%, Female ------22.4% 14.0% 17.7% 30.5%) 20.5%) 22.2%)
Colorectal cancer (C18-C21) RELATIVE SURVIVAL (95% CI) Aged 15-99 1-YEAR Aged 15-44 Aged 45-54 Aged 55-64 Aged 65-74 Aged 75-99 (age- standardised) (73.4%, (69.4%, (71.4%, (68.6%, (59.7%, (68.2%, Male 83.8% 76.0% 75.9% 72.2% 64.1% 70.5% 1993- 94.2%) 82.5%) 80.4%) 75.8%) 68.6%) 72.8%) 1996 (74.8%, (76.4%, (70.5%, (71.4%, (55.5%, (68.2%, Female 84.0% 82.8% 75.5% 75.5% 60.0% 70.4% 93.1%) 89.1%) 80.4%) 79.6%) 64.4%) 72.7%) (75.4%, (80.8%, (79.2%, (73.3%, (55.1%, (70.3%, Male 85.0% 86.3% 83.2% 77.0% 59.7% 72.6% 1997- 94.7%) 91.8%) 87.2%) 80.6%) 64.3%) 74.9%) 2000 (72.5%, (84.5%, (82.1%, (72.3%, (58.9%, (72.1%, Female 82.8% 89.7% 86.1% 76.3% 62.8% 74.3% 93.1%) 95.0%) 90.1%) 80.4%) 66.7%) 76.5%) (81.3%, (73.4%, (76.1%, (73.8%, (61.5%, (72.1%, Male 90.4% 80.5% 80.5% 77.8% 66.4% 74.6% 2001- 99.5%) 87.7%) 84.9%) 81.9%) 71.3%) 77.1%) 2003 (72.3%, (74.9%, (77.6%, (72.9%, (60.7%, (71.9%, Female 83.1% 82.4% 82.9% 77.6% 65.2% 74.4% 93.8%) 89.9%) 88.1%) 82.3%) 69.7%) 77.0%) 5-YEAR (48.0%, (46.1%, (40.6%, (43.1%, (36.0%, (43.2%, Male 61.8% 53.9% 46.1% 47.6% 42.2% 46.2% 1993- 75.6%) 61.7%) 51.6%) 52.2%) 48.4%) 49.3%) 1996 (39.4%, (45.1%, (43.0%, (48.2%, (32.5%, (43.6%, Female 52.0% 53.6% 48.9% 53.3% 37.3% 46.4% 64.5%) 62.1%) 54.8%) 58.5%) 42.1%) 49.2%) (41.7%, (49.3%, (52.1%, (49.6%, (36.9%, (47.9%, Male 55.2% 57.3% 57.7% 54.6% 43.2% 51.1% 1997- 68.8%) 65.3%) 63.3%) 59.6%) 49.6%) 54.3%) 2000 (48.4%, (54.0%, (59.0%, (46.3%, (41.7%, (50.5%, Female 61.8% 62.5% 64.7% 51.5% 46.9% 53.4% 75.1%) 70.9%) 70.5%) 56.6%) 52.1%) 56.4%)
Cancer of the colon (C18) RELATIVE SURVIVAL (95% CI) Aged 15-99 1-YEAR Aged 15-44 Aged 45-54 Aged 55-64 Aged 65-74 Aged 75-99 (age- standardised) (65.8%, (68.9%, (66.9%, (65.3%, (60.5%, (66.8%, Male 80.1% 77.5% 72.9% 69.9% 66.0% 69.7% 1993- 94.5%) 86.2%) 78.9%) 74.5%) 71.4%) 72.7%) 1996 (69.6%, (71.0%, (66.7%, (68.2%, (53.9%, (65.6%, Female 82.4% 79.1% 72.9% 73.1% 59.3% 68.3% 95.3%) 87.1%) 79.0%) 78.0%) 64.8%) 71.0%) (67.8%, (77.1%, (77.9%, (72.4%, (51.7%, (68.0%, Male 81.4% 84.7% 83.1% 77.0% 57.4% 71.0% 1997- 94.9%) 92.3%) 88.4%) 81.6%) 63.0%) 73.9%) 2000 (62.3%, (83.4%, (80.1%, (69.4%, (54.4%, (68.7%, Female 76.6% 89.6% 85.1% 74.5% 59.0% 71.4% 90.8%) 95.9%) 90.1%) 79.5%) 63.6%) 74.1%) (84.8%, (67.0%, (72.9%, (71.0%, (58.7%, (69.6%, Male 94.9% 77.3% 79.0% 76.3% 64.7% 72.8% 2001- 104.9%) 87.6%) 85.2%) 81.7%) 70.8%) 76.1%) 2003 (65.7%, (68.5%, (76.6%, (70.3%, (60.7%, (70.5%, Female 80.9% 79.4% 83.0% 76.0% 66.1% 73.7% 96.0%) 90.4%) 89.5%) 81.6%) 71.5%) 76.9%) 5-YEAR (46.5%, (43.3%, (38.5%, (40.8%, (36.7%, (42.7%, Male 63.9% 53.8% 45.5% 46.6% 44.6% 46.7% 1993- 81.3%) 64.3%) 52.6%) 52.3%) 52.4%) 50.6%) 1996 (39.5%, (41.5%, (42.1%, (48.1%, (33.6%, (43.9%, Female 56.3% 51.5% 49.2% 54.2% 39.6% 47.3% 73.1%) 61.6%) 56.3%) 60.3%) 45.6%) 50.8%) (36.2%, (44.8%, (57.8%, (50.2%, (35.0%, (48.3%, Male 53.7% 55.4% 64.9% 56.5% 42.8% 52.4% 1997- 71.1%) 66.1%) 72.0%) 62.7%) 50.6%) 56.4%) 2000 (33.1%, (53.7%, (60.2%, (45.3%, (42.8%, (50.6%, Female 50.1% 63.7% 67.1% 51.6% 49.0% 54.2% 67.1%) 73.7%) 74.0%) 57.9%) 55.2%) 57.7%)
Northern Ireland Cancer Registry 161
Survival of cancer patients in Northern Ireland: 1993-2004
Cancer of the rectum, rectosigmoid junction and anus (C19-C21) RELATIVE SURVIVAL (95% CI) Aged 15-99 1-YEAR Aged 15-44 Aged 45-54 Aged 55-64 Aged 65-74 Aged 75-99 (age- standardised) (75.8%, (64.1%, (73.8%, (70.4%, (53.1%, (68.2%, Male 89.6% 74.0% 80.4% 76.1% 60.7% 71.9% 1993- 103.4%) 84.0%) 87.0%) 81.8%) 68.3%) 75.5%) 1996 (72.8%, (83.8%, (73.3%, (74.8%, (53.7%, (71.9%, Female 85.8% 92.4% 81.6% 81.9% 61.3% 75.7% 98.8%) 101.0%) 89.8%) 88.9%) 69.0%) 79.5%) (78.0%, (80.7%, (77.1%, (70.8%, (56.4%, (71.6%, Male 90.6% 88.5% 83.4% 76.8% 64.1% 75.2% 1997- 103.2%) 96.3%) 89.6%) 82.9%) 71.9%) 78.9%) 2000 (83.9%, (80.5%, (81.7%, (73.6%, (65.6%, (76.9%, Female 94.5% 90.0% 88.3% 80.3% 72.6% 80.6% 105.1%) 99.6%) 94.9%) 86.9%) 79.6%) 84.2%) (72.1%, (74.6%, (76.0%, (73.9%, (61.3%, (73.6%, Male 86.5% 84.3% 82.3% 80.1% 69.5% 77.4% 2001- 100.9%) 93.9%) 88.6%) 86.3%) 77.7%) 81.3%) 2003 (70.8%, (75.6%, (73.5%, (73.6%, (55.0%, (71.5%, Female 85.8% 85.6% 82.5% 81.9% 63.2% 75.9% 100.8%) 95.7%) 91.4%) 90.1%) 71.4%) 80.4%) 5-YEAR (36.0%, (42.6%, (38.3%, (41.9%, (27.8%, (40.8%, Male 58.4% 54.1% 47.0% 49.5% 37.8% 45.6% 1993- 80.9%) 65.6%) 55.7%) 57.1%) 47.8%) 50.4%) 1996 (28.1%, (43.0%, (37.3%, (41.3%, (24.3%, (39.5%, Female 46.7% 59.0% 48.2% 51.1% 32.4% 44.5% 65.3%) 75.0%) 59.0%) 60.8%) 40.4%) 49.5%) (36.3%, (47.7%, (38.5%, (43.1%, (33.2%, (43.8%, Male 57.7% 59.8% 47.2% 51.3% 44.1% 48.9% 1997- 79.0%) 71.9%) 56.0%) 59.6%) 55.0%) 54.1%) 2000 (66.5%, (43.4%, (49.1%, (42.2%, (31.9%, (46.1%, Female 83.8% 59.4% 59.6% 51.2% 41.4% 51.3% 101.1%) 75.4%) 70.0%) 60.3%) 51.0%) 56.4%)
Lung cancer (C33-C34) RELATIVE SURVIVAL (95% CI) Aged 15-99 1-YEAR Aged 15-44 Aged 45-54 Aged 55-64 Aged 65-74 Aged 75-99 (age- standardised) (18.0%, (22.6%, (23.9%, (18.9%, (14.9%, (21.3%, Male 33.4% 29.5% 28.1% 21.7% 18.2% 23.2% 1993- 48.8%) 36.4%) 32.4%) 24.5%) 21.5%) 25.0%) 1996 (11.6%, (21.5%, (22.5%, (24.6%, (15.2%, (23.4%, Female 30.5% 30.1% 28.1% 28.7% 18.4% 25.9% 49.3%) 38.7%) 33.6%) 32.9%) 21.7%) 28.5%) (23.5%, (31.7%, (27.3%, (23.7%, (17.4%, (25.8%, Male 41.4% 39.8% 31.8% 26.9% 20.8% 27.8% 1997- 59.4%) 47.8%) 36.3%) 30.1%) 24.2%) 29.8%) 2000 (27.0%, (25.7%, (30.1%, (21.2%, (17.7%, (25.6%, Female 46.2% 35.1% 36.3% 25.1% 21.8% 28.2% 65.4%) 44.5%) 42.4%) 29.1%) 25.9%) 30.7%) (22.8%, (23.7%, (23.7%, (16.5%, (24.1%, Male - - 31.6% 28.9% 27.4% 20.4% 26.4% 2001- 40.4%) 34.0%) 31.1%) 24.2%) 28.7%) 2003 (24.9%, (19.7%, (28.6%, (18.9%, (18.3%, (24.4%, Female 47.4% 30.2% 35.2% 23.7% 22.9% 27.3% 69.9%) 40.8%) 41.8%) 28.4%) 27.4%) 30.2%) 5-YEAR (6.3%, (6.3%, (4.4%, (1.3%, (5.7%, Male - - 11.1% 9.1% 6.1% 3.1% 6.9% 1993- 16.0%) 11.9%) 7.9%) 4.9%) 8.1%) 1996 (5.2%, (5.1%, (7.8%, (3.3%, (7.3%, Female - - 11.1% 8.6% 10.8% 6.6% 9.1% 17.1%) 12.2%) 13.8%) 9.9%) 10.9%) (4.4%, (7.0%, (7.5%, (4.3%, (7.9%, Male - - 9.2% 10.1% 9.9% 6.9% 9.3% 1997- 14.0%) 13.2%) 12.2%) 9.5%) 10.8%) 2000 (6.5%, (8.2%, (5.4%, (3.5%, (7.8%, Female - - 13.2% 12.5% 8.0% 6.3% 9.5% 19.9%) 16.9%) 10.6%) 9.0%) 11.3%)
Malignant melanoma (C43) RELATIVE SURVIVAL (95% CI) Aged 15-99 1-YEAR Aged 15-44 Aged 45-54 Aged 55-64 Aged 65-74 Aged 75-99 (age- standardised) (91.9%, (100.5%, (92.5%, (81.2%, (92.9%, (94.5%, Male 96.2% 100.5% 97.6% 90.9% 102.7% 97.4% 1993- 100.6%) 100.5%) 102.7%) 100.7%) 112.6%) 100.3%) 1996 (98.2%, (91.8%, (96.5%, (95.4%, (84.2%, (96.1%, Female 99.4% 96.7% 99.3% 99.4% 94.1% 98.0% 100.7%) 101.6%) 102.2%) 103.5%) 103.9%) 100.0%) (91.2%, (93.2%, (95.1%, (92.8%, (76.2%, (93.3%, Male 95.9% 98.0% 99.1% 99.0% 88.4% 96.2% 1997- 100.6%) 102.7%) 103.1%) 105.2%) 100.5%) 99.1%) 2000 (96.7%, (100.3%, (91.9%, (87.3%, (88.0%, (95.1%, Female 98.7% 100.3% 96.5% 94.0% 95.6% 97.2% 100.6%) 100.3%) 101.2%) 100.7%) 103.1%) 99.2%) (95.6%, (86.1%, (71.9%, (88.4%, (87.5%, (90.7%, Male 98.6% 94.3% 82.4% 95.4% 98.1% 94.1% 2001- 101.6%) 102.4%) 92.8%) 102.3%) 108.7%) 97.5%) 2003 (97.4%, (94.8%, (96.1%, (95.1%, (89.2%, (96.8%, Female 99.2% 98.4% 99.1% 99.0% 96.6% 98.5% 100.9%) 102.0%) 102.1%) 102.9%) 104.0%) 100.3%) 5-YEAR (83.4%, (83.9%, (76.9%, (66.8%, (37.5%, (78.5%, Male 90.3% 93.0% 88.1% 83.4% 66.6% 85.2% 1993- 97.2%) 102.1%) 99.3%) 100.1%) 95.8%) 91.8%) 1996 (96.4%, (80.3%, (80.5%, (71.2%, (70.2%, (86.0%, Female 98.5% 89.1% 89.3% 83.3% 89.0% 90.6% 100.6%) 97.9%) 98.1%) 95.5%) 107.8%) 95.1%) (82.0%, (64.7%, (66.9%, (78.1%, (63.1%, (79.8%, Male 89.4% 78.6% 80.0% 93.9% 88.7% 86.4% 1997- 96.8%) 92.5%) 93.2%) 109.7%) 114.3%) 93.0%) 2000 (97.0%, (81.1%, (88.7%, (78.3%, (81.9%, (90.7%, Female 99.0% 89.9% 95.4% 89.4% 99.9% 94.9% 100.9%) 98.8%) 102.0%) 100.4%) 117.9%) 99.2%)
162
Relative survival by sex, age and cancer site
Breast cancer (C50; females only) RELATIVE SURVIVAL (95% CI) Aged 15-99 1-YEAR Aged 15-44 Aged 45-54 Aged 55-64 Aged 65-74 Aged 75-99 (age- standardised) (95.0%, (94.4%, (94.3%, (88.9%, (78.3%, (91.0%, 1993-1996 96.7% 95.9% 95.8% 91.4% 81.8% 92.0% 98.5%) 97.3%) 97.3%) 93.9%) 85.3%) 93.1%) (97.2%, (97.3%, (95.5%, (92.4%, (84.7%, (94.0%, 1997-2000 98.4% 98.3% 96.8% 94.4% 87.8% 94.9% 99.6%) 99.2%) 98.2%) 96.4%) 90.8%) 95.8%) (96.5%, (97.5%, (97.1%, (92.4%, (82.3%, (93.9%, 2001-2003 98.0% 98.5% 98.2% 94.7% 85.9% 94.9% 99.4%) 99.5%) 99.3%) 97.0%) 89.5%) 95.9%) 5-YEAR (70.6%, (78.4%, (78.1%, (68.3%, (59.2%, (73.2%, 1993-1996 74.9% 81.3% 81.1% 72.7% 65.0% 75.1% 79.3%) 84.2%) 84.2%) 77.0%) 70.8%) 77.0%) (77.5%, (82.2%, (82.7%, (72.6%, (65.2%, (78.0%, 1997-2000 81.1% 84.7% 85.4% 76.6% 71.0% 79.8% 84.8%) 87.3%) 88.2%) 80.7%) 76.7%) 81.5%)
Cervical cancer (C53) RELATIVE SURVIVAL (95% CI) Aged 15-99 1-YEAR Aged 15-44 Aged 45-54 Aged 55-64 Aged 65-74 Aged 75-99 (age- standardised) (89.4%, (77.4%, (67.7%, (56.0%, (33.0%, (76.7%, 1993-1996 93.6% 85.8% 79.1% 70.8% 51.9% 81.1% 97.7%) 94.1%) 90.5%) 85.6%) 70.8%) 85.4%) (88.0%, (77.4%, (72.9%, (70.4%, (25.5%, (78.2%, 1997-2000 92.3% 87.2% 83.2% 82.9% 43.0% 82.3% 96.5%) 97.0%) 93.6%) 95.4%) 60.4%) 86.4%) (93.1%, (82.4%, (71.4%, (49.7%, (24.6%, (78.2%, 2001-2003 96.5% 91.6% 84.4% 69.5% 49.7% 83.6% 99.9%) 100.9%) 97.4%) 89.4%) 74.8%) 88.9%) 5-YEAR (72.5%, (53.3%, (41.1%, (21.0%, (52.6%, 1993-1996 79.4% 64.9% 55.4% 37.8% - - 57.7% 86.2%) 76.4%) 69.7%) 54.6%) 62.8%) (75.8%, (59.7%, (40.3%, (38.7%, (59.7%, 1997-2000 82.0% 72.9% 54.7% 56.7% - - 65.2% 88.2%) 86.2%) 69.1%) 74.6%) 70.6%)
Cancer of the uterus (C54) RELATIVE SURVIVAL (95% CI) Aged 15-99 1-YEAR Aged 15-44 Aged 45-54 Aged 55-64 Aged 65-74 Aged 75-99 (age- standardised) (100.1%, (94.5%, (90.5%, (69.3%, (52.7%, (79.7%, 1993-1996 100.1% 98.4% 94.8% 78.0% 63.9% 83.6% 100.1%) 102.3%) 99.1%) 86.7%) 75.1%) 87.5%) (88.4%, (91.4%, (89.8%, (79.0%, (62.3%, (83.8%, 1997-2000 96.1% 96.1% 94.0% 85.4% 72.4% 87.0% 103.8%) 100.8%) 98.2%) 91.7%) 82.6%) 90.3%) (100.1%, (93.3%, (92.5%, (81.6%, (56.5%, (84.4%, 2001-2003 100.1% 97.3% 95.9% 87.9% 67.2% 87.6% 100.1%) 101.3%) 99.4%) 94.2%) 77.8%) 90.8%) 5-YEAR (72.9%, (75.5%, (43.7%, (24.7%, (59.7%, 1993-1996 - - 83.7% 83.2% 55.0% 38.6% 65.1% 94.6%) 90.8%) 66.3%) 52.5%) 70.6%) (79.3%, (75.7%, (76.7%, (55.1%, (38.8%, (66.6%, 1997-2000 91.5% 84.6% 83.7% 64.5% 52.6% 71.4% 103.6%) 93.4%) 90.8%) 73.9%) 66.4%) 76.3%)
Ovarian cancer (C56) RELATIVE SURVIVAL (95% CI) Aged 15-99 1-YEAR Aged 15-44 Aged 45-54 Aged 55-64 Aged 65-74 Aged 75-99 (age- standardised) (83.5%, (71.0%, (62.9%, (54.8%, (27.7%, (61.1%, 1993-1996 90.4% 79.0% 70.7% 62.8% 37.0% 64.9% 97.2%) 87.1%) 78.4%) 70.8%) 46.2%) 68.7%) (86.0%, (69.9%, (66.7%, (53.5%, (30.3%, (62.0%, 1997-2000 91.4% 77.6% 73.5% 61.3% 39.0% 65.5% 96.8%) 85.3%) 80.2%) 69.1%) 47.8%) 69.0%) (89.3%, (74.2%, (78.6%, (54.8%, (22.1%, (64.6%, 2001-2003 94.3% 82.4% 85.4% 63.9% 30.3% 68.3% 99.2%) 90.6%) 92.3%) 73.0%) 38.5%) 72.0%) 5-YEAR (65.3%, (45.5%, (32.0%, (23.2%, (12.4%, (36.3%, 1993-1996 75.3% 55.5% 40.6% 31.3% 22.0% 40.5% 85.4%) 65.5%) 49.1%) 39.5%) 31.7%) 44.6%) (64.6%, (35.3%, (33.0%, (31.6%, (15.2%, (37.3%, 1997-2000 73.2% 44.6% 40.7% 40.0% 24.6% 41.3% 81.8%) 53.9%) 48.4%) 48.4%) 34.0%) 45.3%)
Northern Ireland Cancer Registry 163
Survival of cancer patients in Northern Ireland: 1993-2004
Prostate cancer (C61) RELATIVE SURVIVAL (95% CI) Aged 15-99 1-YEAR Aged 15-54 Aged 55-64 Aged 65-74 Aged 75-84 Aged 85-99 (age- standardised) (75.5%, (86.2%, (85.4%, (77.2%, (57.6%, (81.5%, 1993-1996 86.2% 90.5% 88.3% 80.7% 65.6% 83.5% 96.8%) 94.8%) 91.2%) 84.2%) 73.6%) 85.4%) (89.5%, (92.0%, (88.6%, (77.1%, (56.2%, (83.2%, 1997-2000 95.8% 94.9% 91.1% 80.6% 64.2% 85.1% 102.2%) 97.8%) 93.7%) 84.1%) 72.1%) 86.9%) (94.0%, (97.3%, (95.2%, (84.3%, (62.6%, (89.5%, 2001-2003 97.8% 98.9% 96.9% 87.8% 71.6% 91.3% 101.5%) 100.4%) 98.7%) 91.4%) 80.7%) 93.1%) 5-YEAR (33.6%, (55.7%, (56.9%, (46.1%, (27.0%, (52.6%, 1993-1996 49.2% 63.0% 61.9% 51.8% 40.3% 55.9% 64.9%) 70.4%) 66.8%) 57.4%) 53.7%) 59.2%) (50.7%, (67.0%, (68.7%, (50.7%, (35.5%, (61.2%, 1997-2000 65.9% 72.9% 73.3% 56.5% 50.3% 64.5% 81.2%) 78.9%) 77.9%) 62.2%) 65.1%) 67.7%)
Cancer of the kidney (C64-C66, C68) RELATIVE SURVIVAL (95% CI) Aged 15-99 1-YEAR Aged 15-44 Aged 45-54 Aged 55-64 Aged 65-74 Aged 75-99 (age- standardised) (79.0%, (59.8%, (58.5%, (54.1%, (47.2%, (61.3%, Male 91.0% 72.7% 69.0% 63.2% 59.6% 66.5% 1993- 103.1%) 85.5%) 79.5%) 72.2%) 71.9%) 71.8%) 1996 (100.1%, (50.9%, (55.2%, (55.3%, (49.6%, (62.0%, Female 100.1% 69.8% 68.7% 66.8% 62.0% 68.4% 100.1%) 88.7%) 82.1%) 78.3%) 74.4%) 74.8%) (64.3%, (64.8%, (58.0%, (58.8%, (45.6%, (62.2%, Male 82.5% 77.0% 69.0% 68.0% 56.7% 67.4% 1997- 100.6%) 89.1%) 79.9%) 77.1%) 67.9%) 72.6%) 2000 (64.3%, (80.8%, (67.8%, (55.0%, (31.0%, (62.1%, Female 82.4% 91.9% 78.8% 66.5% 42.0% 67.7% 100.6%) 103.0%) 89.8%) 77.9%) 53.1%) 73.3%) (50.6%, (69.8%, (49.0%, (53.2%, (41.6%, (57.6%, Male 75.1% 82.7% 59.7% 63.3% 54.0% 63.2% 2001- 99.7%) 95.6%) 70.3%) 73.3%) 66.4%) 68.8%) 2003 (77.1%, (59.1%, (53.4%, (31.3%, (60.5%, Female - - 90.2% 73.5% 67.2% 44.9% 67.5% 103.4%) 87.9%) 81.0%) 58.6%) 74.4%) 5-YEAR (54.6%, (46.9%, (34.1%, (38.6%, (23.3%, (42.7%, Male 73.3% 61.3% 46.0% 49.6% 40.1% 49.2% 1993- 92.1%) 75.8%) 57.9%) 60.5%) 56.9%) 55.7%) 1996 (54.1%, (27.9%, (38.6%, (36.6%, (28.5%, (43.5%, Female 75.5% 48.8% 53.5% 50.0% 45.5% 51.1% 96.8%) 69.6%) 68.5%) 63.5%) 62.6%) 58.8%) (42.3%, (56.3%, (39.5%, (42.5%, (25.5%, (46.4%, Male 65.2% 70.0% 52.1% 53.7% 40.4% 52.8% 1997- 88.2%) 83.7%) 64.6%) 64.8%) 55.3%) 59.1%) 2000 (64.5%, (47.7%, (48.7%, (33.0%, (20.4%, (45.0%, Female 82.8% 67.1% 62.3% 46.1% 34.1% 51.9% 101.0%) 86.6%) 75.9%) 59.2%) 47.8%) 58.9%)
Cancer of the bladder (C67) RELATIVE SURVIVAL (95% CI) Aged 15-99 1-YEAR Aged 15-44 Aged 45-54 Aged 55-64 Aged 65-74 Aged 75-99 (age- standardised) (56.4%, (74.5%, (77.7%, (78.6%, (59.2%, (74.3%, Male 76.6% 86.1% 85.1% 84.2% 66.6% 78.0% 1993- 96.8%) 97.8%) 92.5%) 89.8%) 74.0%) 81.8%) 1996 (57.3%, (58.0%, (55.0%, (45.7%, (57.4%, Female - - 78.8% 74.6% 65.7% 53.1% 63.8% 100.4%) 91.3%) 76.4%) 60.6%) 70.2%) (91.3%, (77.1%, (74.4%, (68.2%, (77.2%, Male - - 97.3% 84.1% 80.5% 75.4% 80.9% 1997- 103.4%) 91.2%) 86.7%) 82.6%) 84.5%) 2000 (56.4%, (54.4%, (35.8%, (56.4%, Female - - - - 73.6% 65.1% 46.3% 62.8% 90.8%) 75.9%) 56.8%) 69.3%) (58.2%, (81.8%, (87.4%, (66.6%, (80.7%, Male - - 76.5% 89.4% 92.9% 74.5% 84.7% 2001- 94.8%) 97.1%) 98.3%) 82.5%) 88.6%) 2003 (48.1%, (40.6%, (52.8%, Female ------63.1% 52.1% 61.7% 78.1%) 63.7%) 70.6%) 5-YEAR (49.3%, (65.1%, (56.8%, (50.1%, (35.2%, (52.3%, Male 71.2% 79.5% 67.3% 58.8% 46.0% 57.8% 1993- 93.0%) 93.8%) 77.8%) 67.4%) 56.8%) 63.2%) 1996 (60.1%, (34.5%, (12.5%, (38.6%, Female - - - - 77.4% 46.8% 22.9% 45.5% 94.6%) 59.1%) 33.2%) 52.5%) (61.6%, (62.6%, (45.2%, (38.0%, (53.0%, Male - - 77.0% 72.0% 54.0% 49.2% 58.5% 1997- 92.4%) 81.4%) 62.8%) 60.4%) 64.0%) 2000 (32.1%, (38.2%, (22.6%, (41.3%, Female - - - - 52.2% 50.7% 35.7% 49.1% 72.2%) 63.1%) 48.8%) 56.8%)
164
Relative survival by sex, age and cancer site
Non-Hodgkin’s lymphoma (C82-C85,C96) RELATIVE SURVIVAL (95% CI) Aged 15-99 1-YEAR Aged 15-44 Aged 45-54 Aged 55-64 Aged 65-74 Aged 75-99 (age- standardised) (72.4%, (62.1%, (66.5%, (42.8%, (41.6%, (58.8%, Male 81.5% 72.3% 76.2% 52.0% 52.3% 63.4% 1993- 90.7%) 82.5%) 85.8%) 61.2%) 62.9%) 68.0%) 1996 (86.3%, (85.7%, (59.9%, (49.8%, (41.4%, (64.0%, Female 94.2% 93.3% 70.3% 58.4% 52.0% 68.3% 102.1%) 101.0%) 80.7%) 67.0%) 62.7%) 72.6%) (70.8%, (76.9%, (62.8%, (53.1%, (44.3%, (63.1%, Male 80.4% 85.5% 71.8% 62.2% 54.8% 67.5% 1997- 90.0%) 94.0%) 80.8%) 71.3%) 65.3%) 72.0%) 2000 (79.8%, (83.6%, (61.5%, (51.9%, (45.1%, (64.3%, Female 88.5% 91.2% 70.6% 60.3% 53.9% 68.4% 97.2%) 98.8%) 79.8%) 68.7%) 62.6%) 72.4%) (82.1%, (67.4%, (63.4%, (58.0%, (48.8%, (66.6%, Male 90.8% 78.8% 73.3% 67.9% 61.6% 71.7% 2001- 99.5%) 90.1%) 83.2%) 77.7%) 74.3%) 76.8%) 2003 (71.8%, (91.4%, (69.1%, (68.7%, (46.1%, (71.0%, Female 85.3% 97.2% 78.5% 77.4% 55.2% 75.3% 98.7%) 103.1%) 87.8%) 86.1%) 64.3%) 79.6%) 5-YEAR (56.6%, (44.6%, (42.6%, (25.4%, (14.1%, (38.4%, Male 67.7% 56.2% 54.5% 35.3% 26.6% 43.7% 1993- 78.8%) 67.7%) 66.4%) 45.2%) 39.1%) 49.1%) 1996 (66.1%, (57.1%, (42.0%, (29.3%, (18.5%, (43.5%, Female 79.8% 71.1% 53.8% 38.4% 28.9% 48.6% 93.4%) 85.1%) 65.5%) 47.6%) 39.3%) 53.7%) (47.3%, (49.6%, (33.0%, (36.1%, (27.8%, (42.8%, Male 59.3% 61.9% 43.4% 46.8% 41.8% 48.4% 1997- 71.4%) 74.2%) 53.8%) 57.5%) 55.8%) 54.1%) 2000 (67.6%, (66.2%, (44.6%, (38.4%, (24.6%, (49.0%, Female 78.9% 77.7% 54.9% 47.8% 35.3% 53.8% 90.2%) 89.1%) 65.3%) 57.2%) 46.0%) 58.7%)
Leukaemia (C91-C95) RELATIVE SURVIVAL (95% CI) Aged 15-99 1-YEAR Aged 15-44 Aged 45-54 Aged 55-64 Aged 65-74 Aged 75-99 (age- standardised) (58.8%, (62.8%, (58.0%, (40.8%, (33.9%, (51.8%, Male 71.5% 80.4% 71.2% 52.1% 44.5% 57.5% 1993- 84.2%) 98.0%) 84.5%) 63.3%) 55.0%) 63.2%) 1996 (40.7%, (38.7%, (30.6%, (39.8%, (45.5%, (47.4%, Female 58.1% 58.5% 47.5% 52.9% 56.1% 54.3% 75.5%) 78.3%) 64.4%) 66.1%) 66.6%) 61.1%) (59.8%, (35.3%, (41.0%, (45.4%, (30.0%, (46.5%, Male 73.8% 53.8% 54.2% 55.1% 40.2% 52.0% 1997- 87.8%) 72.4%) 67.5%) 64.9%) 50.4%) 57.5%) 2000 (70.4%, (48.9%, (48.2%, (36.3%, (34.5%, (50.1%, Female 82.9% 68.4% 67.2% 48.7% 45.3% 56.5% 95.4%) 87.9%) 86.2%) 61.1%) 56.1%) 62.9%) (90.0%, (76.0%, (44.0%, (42.6%, (23.3%, (51.2%, Male 96.7% 89.9% 59.6% 56.4% 35.9% 57.7% 2001- 103.3%) 103.7%) 75.2%) 70.2%) 48.5%) 64.3%) 2003 (56.1%, (50.2%, (36.8%, (34.1%, (52.2%, Female 75.1% - - 70.5% 53.9% 46.7% 60.0% 94.1%) 90.7%) 71.0%) 59.3%) 67.8%) 5-YEAR (31.2%, (26.4%, (11.2%, (11.4%, (23.0%, Male 45.2% - - 41.5% 21.5% 23.1% 29.1% 1993- 59.2%) 56.5%) 31.7%) 34.9%) 35.2%) 1996 (21.6%, (30.6%, (20.1%, (21.7%, (28.0%, Female 38.8% 51.0% - - 33.5% 37.2% 35.6% 56.0%) 71.4%) 46.9%) 52.7%) 43.1%) (25.8%, (31.5%, (20.9%, (6.8%, (24.3%, Male 41.8% - - 45.6% 30.9% 16.9% 30.0% 1997- 57.8%) 59.6%) 41.0%) 27.1%) 35.6%) 2000 (35.0%, (25.1%, (30.6%, (15.4%, (5.6%, (25.3%, Female 51.6% 46.2% 51.8% 27.2% 15.5% 31.8% 68.2%) 67.4%) 73.0%) 39.0%) 25.4%) 38.4%)
Northern Ireland Cancer Registry 165
Survival of cancer patients in Northern Ireland: 1993-2004
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